以急腹症为首发表现的回盲部癌的诊治分析

Diagnosis and treatment of ileocecal cancer with acute abdomen as initial manifestation

目的探讨以急腹症为首发表现的回盲部癌的诊治经验。方法回顾分析2006年3月至2013年5月在本院以急腹症为首发表现的回盲部癌患者17例,平均年龄(56±18.2)岁,5例诊断为急性阑尾炎、4例考虑慢性阑尾炎急性发作入院,行急诊手术;6例考虑为阑尾周围脓肿、2例以阑尾切除术后粘连性肠梗阻入院,完善辅助检查后确诊盲肠癌,行限期右半结肠切除手术。结果所有17例患者均接受手术治疗。急诊手术9例,探查发现回盲肠肿物,其中4例合并急性阑尾炎,患者均行根治性右半结肠切除术。其余8例患者,2例阑尾切除术后不全性肠梗阻,6例阑尾脓肿经治疗后腹部包块仍存在,经腹部CT、结肠镜检查诊为结肠肿瘤,患者均行根治性右半结肠切除术。患者术后均顺利恢复。结论回盲部癌可能首发表现为急腹症。在诊治时应全面检查,综合分析,手术中仔细探查,降低回盲部癌的误诊率。

Objective To investigate the diagnosis and treatment of ileocecal cancer with acute abdomen as initial manifestation. Methods From March 2006 to May 2013, a total of 17 ileocecal cancer patients with acute abdomen as the initial manifestation were admitted to our hospital. Five patients were admitted with an initial diagnosis of acute appendicitis, and 6 were misdiagnosed as periappendiceal abscess and 4 as chronic appendicitis with acute episode,and the other 2 patients presented with postoperative incomplete bowel obstruction after appendectomy. Results All 17 patients received surgical treatment.Nine patients including 5 misdiagnosed as acute appendicitis and 4 as acute episode of chronic appendicitis underwent emergency operation, and ileocecal cancer was confirmed intraoperatively in 9 and ileocecal cancer combined with acute appendicitis in 4 cases, then radical right hemicolectomy was performed. The other 8 patients including 6 misdiagnosed as peri-appendiceal abscess and 2 with postoperative bowel obstruction after appendectomy were initially treated conservatively, and underwent radical right hemicolectomy after ileocecal cancer was detected by abdominal CT and colonoscopy. All patients successfully recovered postoperatively. Conclusions Patients with ileocecal cancer may initially present with acute abdomen. A detailed history and careful examinations are warranted before the diagnosis and treatment are attempted, and intraoperative careful exploration is necessary.