结直肠癌根治术后良性肠梗阻24例分析

Analysis of 24 cases of benign intestinal obstruction after radical operation for colorectal cancer

目的探讨结直肠癌根治术后良性肠梗阻的病因、临床表现、治疗方法以及防治措施。方法收集2007年5月—2013年8月接受结直肠癌根治术治疗的360例患者临床资料,其中24例发生良性肠梗阻,分析良性肠梗阻的发病原因、临床表现(包括生活质量)、治疗方法及防治措施。结果良性肠梗阻占接受结直肠癌根治术治疗患者的6.7%(24/360)。其中机械性肠梗阻83.3%(20/24),动力性肠梗阻16.7%(4/24)。机械性肠梗阻病因包括:肠粘连35%(7/20),急性胃肠炎45%(9/20),放疗10%(2/20),造瘘口挛缩5%(1/20),疝5%(1/20);动力性肠梗阻病因包括:化疗75%(3/4),手术25%(1/4)。良性肠梗阻的发生与性别无关(chi2=0.1169,pr=1.732)。良性肠梗阻在结肠癌与直肠癌患者之间无明显差异(chi2=0.3280,pr=0.567)。良性肠梗阻临床表现有腹痛、呕吐、腹胀、停止排气排便,患者均有中度以上疼痛,生活质量卡氏评分均不超过60分。本组7例患者接受手术治疗,17例患者接受保守治疗,所有患者治疗后肠梗阻均解除。结论良性肠梗阻为结直肠癌根治术后影响患者生活质量的因素之一,临床医生应及早进行诊断,及时治疗。

Objective To investigate the effect of quality of life in patients with colorectal cancer by benign intestinal ob-struction after radical resection, and to discuss the causes, the clinical manifestation, the treatment, and the preventing measures.Methods We retrospective analysised 360 cases underwent radical resection of colorectal cancer from May 2007 to August 2013,of 24 patients had benign intestinal obstruction, and we discussed the causes,the clinical manifestation （ quality of life was included） ,the treatment, and the preventing methods.Results The occurrence of Benign intestinal ob-struction was 6.7%（24/360）.Of the intestinal Mechanical obstruction was 83.3% （20/24）, Of the dynamic ileus was 16.7%（4/24）.The cause of mechanical intestinal obstruction included that intestinal adhesion was 35%（7/20）, acute gastroenteritis was 45%（9/20）, radiotherapy was 10% （2/20）, narrow fistula was 5% （1/20）, and hernia was 5%（1/20）;The cause of dynamic ileus included that chemotherapy was 75%（3/4）, and surgery was 25%（1/4）.Gender was not associated with benign intestinal obstruction after radical resection（chi2 =0.1169,pr=1.732）.There was no sig-nificant difference between patients with colon cancer and patients with rectal cancer（ chi2 =0.3280,pr=0.567） .Clinical manifestations included abdominal pain, vomiting, abdominal distension, stopping passing flaut,and stopping defecation. All patients had moderate or severe pain,and the quality of life of Karnofsky score was less than 60 points.7 patients under-went surgery,and 17 patients received conservative treatment.Conclusion Benign intestinal obstruction is one of the factors that affect the quality of life of patients with colorectal cancer after radical resection.Clinicians should be early give patients diagnosis, and give patients timely treatment.