【摘要】 目的 探讨结直肠癌并发急性肠梗阻的外科治疗经验。方法 回顾性分析2006年1月—2009年9月92例结直肠癌并发急性肠梗阻手术病人的临床资料，其中右半结肠癌24例，横结肠癌6例,左半结肠或直肠癌62例。结果 92例病人中一期切除36例,二期切除29例,捷径手术27例。合并内科病症者47例,占51.1%;术后出现切口感染15例，肺部感染5例，腹腔感染4例，胸腔积液1例，肺栓塞1例，肠瘘1例，经积极治疗后痊愈。死亡3例，其中2例因多脏器功能衰竭而死亡，1例因肿瘤侵及输尿管致出血，放弃治疗死亡。术后并发症发生率为27.2%，手术病死率为3.3%。结论 对结直肠癌并急性肠梗阻的病人,应根据其自身的特点,选择合理的手术时机和手术方式,做好围手术期的处理是减少并发症、降低病死率的关键。
【关键词】 结直肠肿瘤;急性肠梗阻;外科手术;手术后并发症;预后
[ABSTRACT] Objective To review the experience on surgery for colorectal carcinoma presenting with acute intestinal obstruction. Methods A retrospective analysis was made on the clinical data, Jan. 2006-Sep. 2009, of 92 cases of colorectal carcinoma complicated with acute intestinal obstruction due to cancer of right hemicolon (24 cases); transverse colon (6 cases), and left hemicolon or retum (62 cases). Results Of the 92 patients operated, one?stage resection was done in 36 patients, two?stage resection in 29, and bypass surgery in 27. Those with morbus internus accounted for 51.1% (47 patients). Postoperative complications were infection of incisional wound (15 cases), pulmonary infection (5 cases), infection of abdominal cavity (4 cases), pleural effusion (1 cases), pulmonary embolism (1 cases), and intestinal fistula (1 cases). All patients with postoperative complications were cured. Two died of multiple organ failure, and one died of bleeding caused by ureter involvemnt. Post?operative complication rate was 27.2%, and mortality was3.3%. Conclusion For colorectal cancer presenting with acute intestinal obstruction, timely proper operation should be done according to the specific features of the individual. Intensive perioperative care is the key in reducing postoperative complications and mortality.
[KEY WORDS] colorectal neoplasms; intestinal obstruction; surgical procedures, operative; postoperative complications; prognosis
结直肠癌并发急性肠梗阻是临床常见的急腹症之一，文献报道结直肠癌致结肠梗阻的发生率可达8%～30%,成人结肠梗阻中约40%由结直肠癌引起[1?2]。由于起病隐匿，发展缓慢，易被人们忽视。当出现典型肠梗阻表现时，临床处理往往非常棘手。而选择正确的手术时机、手术方式以及围手术期处理关系到治疗结果。2006年1月—2009年9月，我院共收治急性癌性肠梗阻病人92例, 现将外科治疗情况报告如下。
1 资料与方法
1.1 一般资料
本组92例中，男52例,女40例;年龄24～95岁,中位年龄63岁;病程6 h～10 d,均有腹胀、腹痛,大便习惯改变或便血史，肛门停止排气、排便39例。本组结直肠癌病人均经纤维结肠镜或术后病理检查确诊。
1.2 梗阻部位
右半结肠癌24例，其中回盲部癌9例，升结肠癌9例及结肠肝曲癌6例;横结肠癌6例;结肠脾曲癌11例;降结肠癌7例;乙状结肠癌26例;直乙状结肠交界或直肠癌18例。
1.3 临床病理分期
DUKES分期: A期1例(降结肠癌并肠套叠),B期34例,C 期33例,D期24例; UICC TNM分期(1997年): Ⅰ期1例,Ⅱ期34例, Ⅲ期34例, Ⅳ期23例。病理组织学分类:中、高分化腺癌62例,低分化腺癌18例,黏液腺癌8例,印戒细胞癌1例, 弥漫性大B细胞恶性淋巴瘤2例，侵袭性纤维瘤1例。