局部晚期右半结肠癌侵犯十二指肠的诊断与外科治疗原则分析

Diagnosis and surgical treatment of locally advanced right-sided Colon Cancer with duodenum Invasion

目的探讨局部晚期右半结肠癌侵犯十二指肠的诊疗方法,分析外科治疗原则。方法选取2017年6月至2019年1月于本院就诊的47例局部晚期右半结肠癌患者为研究对象,采取体征观察、影像学检查、内镜检查及术中探查等方法进行诊断,判断肿瘤组织侵犯十二指肠的具体情况。基于患者个体情况,选择恰当、合理的外科手术进行治疗,观察治疗恢复效果。结果47例局部晚期右半结肠癌患者中,经临床诊断后,检出十二指肠受侵38例。手术治疗期间,经术中探查发现,在十二指肠受侵的局部晚期右半结肠癌患者中,Ⅰ型患者28例,采用十二指肠肠壁浆肌层切除术进行治疗;Ⅱ型患者10例,采用空肠十二指肠端侧吻合术+空肠十二指肠侧侧吻合术或右半结肠切除术+胰十二指肠切除术进行治疗。手术治疗后,患者治疗有效率为76.60%,并发症发生率为27.66%。结论基于局部晚期右半结肠癌侵犯十二指肠的诊断结果,明确外科治疗原则,根据患者实际情况,选择合适的手术治疗方法,可以获得更加理想的治疗效果。

Objective To investigate the diagnosis and treatment of locally advanced right colon cancer invading the duodenum,and to analyze the principles of surgical treatment.Methods From June 2017 to January 2019,47 patients with locally advanced right-sided colon cancer were selected as the study subjects.Physical signs,imaging,endoscopy and intraoperative exploration were used for diagnosis,and to determine the extent to which the tumor duodenum.Based on the individual condition of the patients,appropriate and reasonable surgical operation was selected for treatment,and the effect of treatment recovery was observed.Results Of the 47 patients with locally advanced right colon cancer,38 were found to have duodenum involvement.During the course of surgical treatment,intraoperative exploration revealed that 28 patients with locally advanced right colon cancer with duodenum involvement were treated with duodenum resection;10 patients with type II cancer,end-side jejunal duodenum plus duodenum or right hemicolectomy plus pancreaticoduodenectomy were used.After operation,the effective rate was 76.60%,and the complication rate was 27.66%.Conclusion Based on the diagnosis of locally advanced right hemicolon carcinoma invading the duodenum,a better surgical treatment can be achieved by defining the surgical treatment principles and choosing the appropriate surgical treatment according to the actual conditions of the patients.