升结肠回盲部肿瘤侵犯乙状结肠22例治疗体会

Surgical treatments of 22 cases of ascending colon and ileocecal neoplasms invading sigmoid colon

目的总结升结肠回盲部肿瘤侵犯乙状结肠的治疗经验。方法升结肠回盲部肿瘤侵犯乙状结肠22例,术前诊断明确7例,其余均为术中明确诊断,急诊手术11例(占50.0%),均行多发结肠肿瘤肠段切除术,其中一期吻合5例,预防性小肠造口11例,降结肠造口6例,包括右侧输尿管部分切除5例,肉眼达到R0根治性切除21例,1例因右侧髂内血管侵犯行姑息性肿瘤切除。结果术后患者恢复好,无死亡患者,无肠漏及吻合口漏。预防性小肠造口患者于术后1个月余行造口还纳手术,3例降结肠造口患者于术后半年行造口还纳术,另有3例随访无异常。结论升结肠回盲部肿瘤侵犯乙状结肠患者行根治性肿瘤切除,可提高患者生存率及生活质量,采用多肠段切除一期吻合或预防性小肠造口是一种合理的手术方式,如必须行结肠造口术时,需为二次手术创造条件。

Objective To discuss the surgical treatment experiences of ascending colon and ileo-cecal neoplasms invading sigmoid colon. Methods 7 cases were accurately diagnosed before operation in 22 cases,the others were accurately diagnosed during operation,the emergency operation rate was fifty per-cent. Multiple colonic neoplasms were resected in all 22 cases by surgery,including 5 cases of synchronism suture,11 cases of preventive ileostomy and 6 cases of descending colostomy,and 5 cases of right ureter resection partly. 21 cases got naked Ro radical resection,one case was palliative resected due to tumor in-vasion of the right internal iliac vessels. Results All patients recovered well,no case died,intestinal fis-tula and stomal leak. The patients of preventive ileostomy were restored by operation after one month from first operation,3 cases were restored after 6 months from first operation,and 3 cases were normal after fol-lowed-up. Conclusion Radical resection is necessary for the colonic neoplasms invading sigmoid colon. It could improve the survival rate and quality of life. The way of multiple colonic neoplasms resection with synchronism suture or preventive ileostomy is feasible operation method,if descending colostomy is nee-ded,we must provide convenient conditions for next operation.