结直肠癌并发急性肠梗阻手术方式的选择

Surgical management of colorectal cancer complicated with acute obstruction

目的探讨结直肠癌并发急性肠梗阻的外科治疗方法。方法分析1992年1月～2002年12月收治的108例结直肠癌并发急性肠梗阻的外科治疗情况。结果 I期切除吻合59例,切除肿瘤、双结肠造口6例,Hartmann手术20例,单纯结肠造口18例,肠捷径手术5例。全组切口感染8例(7.4％),肺部感染6例(5.5％),术后死亡2例(1.9％)。无吻合口瘘发生。结论结直肠癌并发急性肠梗阻的手术方式应首选I期切除吻合,对不宜I期吻合者可采用双结肠造口或Hartmann手术以策安全。

Objective To study the surgical management of colorectal cancer complicated with acute obstruction. Methods The surgical management of 108 cases of colorectal cancer complicated with acute obstruction, admitted to our hospital,from January, 1992 to December,2002 was analyzed retrospectively. Results There were 59 cases underwent primary anastomosis, 6 cases underwent double colon fistulization, 20 cases underwent Hartmann operation. In addition, there were 18 cases underwent permanent colon dual cavity fistulization and 5 cases underwent bowel bypass operation.In the whole group, there was an incidence of 7. 4% (8/108) incisional infection, 5.5%(6/108) pulmonary infection, 1.9% (2/108) postoperative death and no occurrence of anastomotic fistula. Conclusion Tumor restection with stage I anastomosis for colorectal cancer complicated with acute obstruction should be performed appropriately. For those cases difficult to underwent stage I anastomosis, colon dual cavity fistulization or Hartmann operation could be accepted for safety.