结肠癌伴穿孔的术式研究

Research on the operation mode of colon cancer with perforation

目的探讨结肠癌伴穿孔的手术方式。方法回顾性分析2000~2011年我院收治的21例结肠癌伴穿孔患者的临床资料,所有患者均行手术治疗。行肿瘤一期切除吻合14例,包括全部的右半结肠癌伴穿孔和4例一般状况较好,发病时间较短,感染、梗阻较轻的左半结肠癌伴穿孔;行肿瘤一期切除,近端造瘘、远端封闭6例,均为左半结肠癌伴穿孔;单纯修补穿孔+近端结肠双腔造瘘1例,为乙状结肠癌伴穿孔,因肿瘤与盆底部及盆腔脏器粘连固定不能切除。观察患者手术情况包括手术时间、术中出血量、肛门排气时间、术后住院时间。统计患者术后并发症包括切口感染、吻合口瘘、肺部感染、围手术期死亡发生率及患者1、3、5年存活率。结果本组21例手术时间为(100.5±25)min,术中出血量为(60±15)ml,肛门排气时间为(3.1±0.8)d,术后住院时间为(10±1.6)d。切口感染5例(23.8%),经切开引流换药后二期愈合。吻合口瘘3例(14.3%),2例在左半结肠,1例在右半结肠,2例经禁食及生理盐水持续冲洗后痊愈,未行二次手术,1例左半结肠吻合口瘘行二次手术但仍因感染严重死亡。肺部感染4例(19.0%),经抗炎、化痰及雾化吸入等治疗后治愈。术后围手术期死亡2例(9.5%)。1年存活16例(76.2%),3年存活9例(42.9%),5年存活6例(28.6%)。结论结肠癌伴穿孔应根据具体情况选择个体化的手术方式,对右半结肠癌伴穿孔行肿瘤一期切除吻合是可行的;而对于左半结肠癌伴穿孔行肿瘤一期切除,近端造瘘、远端封闭是安全有效的。

Objective To explore the operation method of colon cancer with perforation.Methods21cases of colon cancer with perforation patients from2000to2011in our hospital were analyzed retrospectively.All patients underwent surgery,14cases underwent I tumor resection and anastomosis,including all of the right colon perforation,and4cases of better general condition,shorter onset of infection,obstruction of the left colon perforation lighter;6cases of left colon underwent I tumor resection and the proximal end of the distal fistula closure perforation,1case underwent perforation+simple repair double-lumen proximal colon colostomy,and was sigmoid colon carcinoma with perforation,because the tumor with pots and bottom fixed unresectable pelvic organ adhesions.Observed the operative time,blood loss,anal exhaust time and postoperative hospital stay.Postoperative complications included wound infection,anastomotic fistula,pulmonary infection,perioperative morbidity and mortality in patients with1,3,5-year survival.Results21cases of surgical time was(100.5±25)min,blood loss was(60±15)ml,anal exhaust time was(3.1±0.8)d,postoperative hospital stay was(10±1.6)d,incision infection in5cases(23.8%),healed after incision and dressing.Anastomotic leakage in3cases(14.3%),2cases in the left colon,and1case in the right colon,2cases healed without secondary surgery by fasting and saline continuous irrigation,1case of left colon fistula underwent secondary surgery but died due to serious infection.Pulmonary infection in4cases(19.0%)and cured after the anti-inflammatory,expectorant and inhalation therapy.Postoperative perioperative death in2cases(9.5%).1year survival of16cases(76.2%),3year survival of9cases(42.9%),5-year survival of6cases(28.6%).Conclusion Colon carcinoma with perforation should be chosen individualized surgical approach depending on the circumstances.For perforation of the right colon tumor resection and anastomosis is feasible.As for the left colon perforation with a tumor resection,colostomy proximal and distal closure is safe and effective.