宫颈癌根治性放疗后容易漏诊误诊的肠梗阻类型及处理方法探讨

Types and treatment of easily-missed,misdiagnosed intestinal obstruction after radical radiotherapy of cervical cancer

目的探讨宫颈癌根治性放疗后容易漏诊、误诊的肠梗阻类型及处理方法。方法收集郑州大学附属肿瘤医院收治的21例宫颈癌放疗后肠梗阻患者的临床资料,包括术前患者的放疗剂量、梗阻症状、手术方法及效果,根据治疗效果分析梗阻类型及处理对策。结果 21例患者均为宫颈癌根治性放疗后出现肠梗阻,初次判断均为直肠梗阻。首次均行横结肠双腔造口术,15例患者成功解除梗阻症状,而6例患者未能解除梗阻症状,遂行二次手术探查。6例患者中,4例为直肠梗阻合并回肠中、末段梗阻,行回肠双腔造口术;另2例为单纯性回肠末段梗阻,行回肠横结肠侧侧吻合+部分肠管旷置术。二次手术后均顺利解除梗阻症状。结论宫颈癌根治性放疗后发生的肠梗阻中,直肠梗阻占多数,但存在回肠中、末段部位梗阻的可能性,手术前应完善检查,避免漏诊、误诊,根据梗阻部位采取相应的手术方式。

Objective To investigate the types and treatment methods of easily-missed,misdiagnosed intestinal obstruction after radical radiotherapy of cervical cancer.Methods The clinical data of 21 patients with intestinal obstruction after radical radiotherapy of cervical cancer in our hospital from May 2013 to May 2019 were collected,including the radiation dose,obstruction symptoms,surgical methods and treatment outcomes.The types and treatment methods of intestinal obstruction after radical radiotherapy of cervical cancer were further investigated.Results The intestinal obstruction occurred in 21 patients with cervical cancer after radical radiotherapy.All patients were initially diagnosed as rectal obstruction and undenvent the transverse colostomy.The obstruction symptoms were successfully resolved in 15 patients while failed in other 6 patients who then underwent the re-operation.Four patients with rectal obstruction accompanied by middle or terminal ileum obstruction underwent ileostomy,the other 2 patients with terminal ileum obstruction underwent the transverse ileal anastomosis and partial intestines exclusion surgery.All of the obstruction symptoms were alleviated.Conclusions Rectal is the major obstruction site of the cervical cancer patients with intestinal obstruction after radical radiotherapy.However,a possibility of obstruction at the middle or end of the ileum also exists.Therefore,it is very important to avoid misdiagnosis and conduct appropriate operative treatment according to the obstruction site.