胃肠癌术后伪膜性肠炎回顾分析

Retrospective studies of pseudomembranous colitis after gastrointestinal cancer surgery

目的研究我院胃肠癌术后发生伪膜性肠炎的临床特点。方法分析我科2010年1月至2012年12月收治的236例胃癌、结肠癌以及直肠癌术后发生伪膜性肠炎患者的临床资料。结果236例患者所患疾病:胃癌61例,结肠癌98例,直肠癌77例。患者年龄范围35~78岁,平均年龄64.5岁。其中201例患者于术后6天内发生伪膜性肠炎。236例患者均常规予以鼻饲甲硝唑,肠道益生菌治疗,其中61例患者加用口服万古霉素治疗。233例患者治愈康复,3例死亡。结论高龄、抗菌药物应用种类多、时间长以及术后胃酸分泌减少是术后伪膜性肠炎的高危因素。合理应用抗生素、注意早期肠内营养的应用,减少伪膜性肠炎的发生。另外,早期诊断、早期治疗以及隔离治疗对伪膜性肠炎患者是十分必要的。

Objective To study the clinical features of pseudomembranous colitis ( PMC ) in our surgical ward.Methods The clinical data of 107 men and 129 women who developed PMC from January 2010 to December 2012 were analyzed.Results The underlying diseases were as follows:gastric cancer( n=61),colon cancer(n=98)and rectal cancer(n=77).The mean age of patients was 64.5 years(range 35-78 ) .In 201 cases PMC developed within 6 days of operation.All patients were treated with metronidazole and bacillus bifidus,61plus vancomycin through a nasogastric tube or by oral .233 patients survived and3 died. Conclusions Patients who are given broad-spectrum antibiotics and whose gastric secretion is reduced are at high risk of PMC.The reasonable application of antibiotics and paying attention to the early application of enteral nutrition can reduce the occurrence of PMC.In the surgical ward, early diagnosis, treatment and isolation are essential for patients with PMC.