肠道恶性肿瘤引起肠梗阻22例分析

Analysis of 22 Cases of Intestinal Obstruction Caused by Intestinal Malignant Tumor

目的分析肠道恶性肿瘤引起肠梗阻临床特征,评估肠梗阻临床治疗效果,探讨肠梗阻发生与转归影响因素,为肠道恶性肿瘤引起肠梗阻防治提供指导。方法选取2019年1月至2020年12月本院收治肠道恶性肿瘤患者临床资料进行回顾性分析。根据肠梗阻发生情况将其分为肠梗阻组与非肠梗阻组,对比两组临床特征,统计肠梗阻患者转归情况,采用Pearson相关性分析法探究肠梗阻转归相关因素。结果本次共采集肠道恶性肿瘤患者142例,肠梗阻22例,肠梗阻发生率15.49%;肠梗阻患者与非肠梗阻患者在临床分期、复合转移、肿瘤病理类型、治疗药物、手术史等方面存在显著差异(P<0.05);22例肠梗阻患者10例保守治疗,2例保守治疗无效转手术治疗,10例手术治疗,10例保守治疗患者治疗2~20d(10.54±2.06)d,治疗10 d时肠梗阻7例转归,相关症状基本消失,3例肠梗阻未完全解除,临床治疗有效率70.00%,治疗10 d时胃肠道功能评分(2.83±0.41)分低于治疗前(10.54±1.77)分(P<0.05),证候积分(1.99±0.21)分低于治疗前(6.84±1.24)分(P<0.05);12例手术治疗患者手术时间(120.58±40.65)min,术中出血量(144.85±15.98)mL,肠鸣音恢复时间(14.12±2.05)h,首次排气时间(17.87±4.65)h,首次排便时间(30.05±6.54)h,住院时间(12.24±3.55)d,术后癌胚抗原(carcinoembryonic antigen,CEA)(14.45±2.24)ng/mL低于术前(21.12±3.36)ng/mL(P<0.05),未见手术死亡病例。22例肠梗阻见2例感染、1例血肿、1例腹泻,并发症总发生率18.18%。肠梗阻转归与手术时间、梗阻发生时间、原发病临床疗效等存在相关性(P<0.05)。结论影响肠道恶性肿瘤发生肠梗阻的因素较多,且肠梗阻转归受原发病治疗效果、手术时间等因素影响较大,临床应根据患者情况系统评估肠梗阻风险给予针对性预防,同时在患者确诊肠梗阻后进行积极、有效治疗,切实提高临床疗效,降低疾病对患者健康的伤害。

Objective To analyze the clinical characteristics of intestinal obstruction caused by intestinal malignant tumor,evaluate the clinical treatment effect of intestinal obstruction,explore the influencing factors of the occurrence and outcome of intestinal obstruction,and provide guidance for the prevention and treatment of intestinal obstruction caused by intestinal malignant tumor.Methods The clinical data of patients with intestinal malignant tumors admitted to our hospital from January 2019 to December 2020 were retrospectively analyzed.According to the occurrence of intestinal obstruction,they were divided into intestinal obstruction group and non intestinal obstruction group.The clinical characteristics of the two groups were compared,and the outcomes of patients with intestinal obstruction were counted.Pearson correlation analysis was used to explore the related factors of intestinal obstruction outcomes.Results 142 patients with intestinal malignant tumor were collected,22 patients with intestinal obstruction,the incidence of intestinal obstruction was 15.49%.There were significant differences between patients with intestinal obstruction and patients without intestinal obstruction in clinical staging,compound metastasis,tumor pathological type,therapeutic drugs,and surgical history(P<0.05).Twenty two patients with intestinal obstruction were treated conservatively in 10 cases,2 patients with ineffective conservative treatment were converted to surgical treatment,10 patients were treated surgically,10 patients with conservative treatment were treated for 2-20 days(10.54±2.06)days,7 patients with intestinal obstruction were recovered after 10 days of treatment,and related symptoms were basically disappeared,3 patients with intestinal obstruction were not completely relieved,the clinical treatment effective rate was 70.00%,and the gastrointestinal function score(2.83±0.41)at 10 days of treatment was lower than that before treatment(10.54±1.77)(P<0.05),syndrome score(1.99±0.21)was lower than that before treatment(6.84±1.24)(P<0.05).The operation time of 12 patients with surgical treatment was(120.58±40.65)min,the amount of intraoperative bleeding was(144.85±15.98)mL,the recovery time of bowel sounds was(14.12±2.05)h,the time of first exhaust was(17.87±4.65)h,the time of first defecation was(30.05±6.54)h,and the hospital stay was(12.24±3.55)d.The postoperative carcinoembryonic antigen(CEA)(14.45±2.24)ng/mL was lower than the preoperative(21.12±3.36)ng/mL(P<0.05),no operative death was found.In 22 cases of intestinal obstruction,there were 2 cases of infection,1 case of hematoma and 1 case of diarrhea.The total incidence of complications was 18.18%.The prognosis of intestinal obstruction was correlated with the time of operation,the time of occurrence of obstruction and the clinical efficacy of primary disease(P<0.05).Conclusion There are many factors that affect the intestinal obstruction of intestinal malignant tumors,and the prognosis of intestinal obstruction is greatly affected by the treatment effect of the primary disease,operation time and other factors.The clinical should systematically evaluate the risk of intestinal obstruction according to the patient's situation and give targeted prevention.At the same time,active and effective treatment should be carried out after the patient's diagnosis of intestinal obstruction,so as to effectively improve the clinical efficacy and reduce the harm of disease to the patient's health.