Ⅰ期肠切除术和吻合术治疗结肠癌合并肠梗阻的临床研究

Clinical Study of StageⅠBowel Resection and Anastomosis for Colorectal Cancer Combined with Intestinal Obstruction

目的:观察结肠癌合并肠梗阻的手术疗效,为临床选择合理手术方式提供依据。方法:选取2012年3月-2015年2月本院肿瘤科收治的结肠癌合并肠梗阻患者87例,按手术方式的不同分为观察组和对照组两组。观察组(44例)采用Ⅰ期肠切除术和吻合术治疗,对照组(43例)行Ⅰ期切除肠造瘘术,Ⅱ期吻合术治疗。两组均进行为期>2年的随访,比较两组手术效果、住院时间、费用、疗效、住院期间患者死亡率、并发症发生率和末次随访时患者的复发率和转移率。结果:两组手术时间、术中出血量、住院天数和费用比较,观察组均少于对照组(P<0.05)。观察组治疗总有效率(93.18%)明显高于对照组(69.77%),差异有统计学意义(P<0.05)。观察组并发症发生率为25.00%,明显低于对照组的58.14%(P<0.05)。两组住院期间患者死亡率和转移率比较,观察组均低于对照组,但差异均无统计学意义(P>0.05);观察组2年内复发率(2.27%)明显低于对照组(13.95%),差异有统计学意义(P<0.05)。结论:相比Ⅰ期切除肠造瘘术和Ⅱ期吻合治疗,Ⅰ期肠切除术和吻合术的手术方案疗效确切,患者预后较好,降低了术后并发症发生率和疾病复发率,是临床治疗结肠癌合并肠梗阻较理想的手术方式。

Objective:To observe the curative effect of colon cancer combined with intestinal obstruction,and to provide the basis for the clinical choice of reasonable surgical treatment.Method:The patients with colon cancer combined with intestinal obstruction treated in our hospital were chosen from March 2012 to February 2015,87 cases were divided into the observation group and the control group.The observation group(44 cases)treated with stageⅠbowel resection and anastomosis,the control group(43 cases)treated with stageⅠbowel resection and colostomy,stageⅡanastomosis.Two groups were followed up for>2 years,the operation effect,the length of time,cost,efficacy,mortality during hospitalization,the incidence of complications and metastasis and recurrence rate at the time of the last follow-up of two groups were compared.Result:The operation time,the amount of bleeding,the days of hospitalization and the cost were compared between two groups,and the observation group were less than those of the control group(P<0.05).The total effective rate of the observation group(93.18%)was significantly higher than that of the control group(69.77%),and the difference was statistically significant(P<0.05).The incidence of complications of the observation group was 25.00%,which was significantly lower than 58.14%of the control group(P<0.05).Compared with the control group,the mortality and transfer rate of the observation group were lower than those of the control group,but the differences were not statistically significant(P>0.05).The recurrence rate of the observation group in 2 years was 2.27%,it was significantly lower than 13.95%of the control group,and the difference was statistically significant(P<0.05).Conclusion:Compared with stage stageⅠbowel resection and colostomy,stageⅡanastomosis,stageⅠbowel resection and anastomosis is effective,with better prognosis,lower postoperative complication rate and relapse rate.It is an ideal surgical way for clinical treatment of colon cancer combined with intestinal obstruction.