结肠癌并发急性肠梗阻患者手术时机及术式的选择对临床效果的影响

Effect of Surgical Timing and Surgical Selection on the Clinical Outcome in Patients with Colon Cancer Complicated with Actual Intestinal Obstruction

【目的】探讨结肠癌并发急性肠梗阻患者手术时机及术式的选择对临床疗效的影响。【方法】选择2016年1～¨月本院收治的由结肠癌并发的急性肠梗阻60例患者，所有患者在手术方案上均采用I期切除吻合术。根据患者病情，其中20例患者充分术前准备基础上即刻给予I期切除吻合术（A组）；20例患者保守治疗8～12h后行I期切除吻合术（B组），20例患者保守治疗2～3d后行I期切除吻合术（C组）。对上述三组患者的手术情况进行统计分析，比较三组患者不同时机手术治疗的临床效果。【结果】A组、B组治疗总有效率高于C组，但组间比较差异无统计学意义（P〉0．05）。三组不同手术时机治疗的患者手术时间、住院时间、治愈出院及病死例数方面比较，差异均无统计学意义（均P〉0．05）。【结论】结肠癌并发急性肠梗阻患者只要根据的病情选择适当的手术时机行I期切除吻合术均可取得较好的临床效果。

[Objective]To investigate the effects of surgical timing and surgical selection on clinical out- come in patients with colon cancer complicated with actual intestinal obstruction.[Methods]Sixty cases of colon cancer patients complicated by actual intestinal obstruction were collected from January to November, 2016 in our hospital for the study. All patients underwent stage I resection and anastomosis and the procedure of sur- gery were recorded. Among 60 cases, 20 patients received the surgery immediately after proper completion of preoperative preparation （group A）, 20 received the same surgery after 8~12 hours of conservative treatment （group B）, and 20 had surgery after 2~3 days of conservative treatment （group C）. As to the intraoperative treatment of the bowel, 25 cases adopted traditional Dudley lavage and 35 cases were applied with modified Dudley lavage. The number of case of anastomotic fistula, abdominal infection, and death under different cir- cumstance of bowel treatment and position of actual intestinal obstruction were analyzed and compared among the three groups. [Resutts]Surgery with stage I resection and anastomosis showed good curative effect in all patients without low anastomotie fistula and abdominal infection. Patients in group A had a better clinical out- come; patients in group C were cured and discharged. There was one case of death after surgery in group B. The time of operation, hospitalization, and discharge did not show significant difference among the three groups （ P 〉0.05）. In the traditional Dudley lavage, 3 cases （3/25,12 %） had anastomotic fistula, 3 cases had abdominal infection, and 1 died. However, there were no complication and death seen in the modified Dudley lavage with colon decompression. Statistically, the difference was significant in between the two methods （ P 〈0.05）. One died in 30 cases of left colon cancer complicated with actual intestinal obstruction and no death was in 30 cases of right colon cancer complicated with actual intestinal obstruction; the difference was not sta- tistically significant （ P 〉0.05）. [Conclusion]A certain difference exists between different times of treatment and applications of different methods in colon cancer complicated with actual intestinal obstruction. Careful se- lection of the surgery timing is of important.