结直肠癌并发急性穿孔的诊断和治疗

目的探讨结直肠癌并发急性穿孔的临床特点及其诊断和治疗。方法回顾性分析19年间本院收治的38例结直肠癌并发急性穿孔的临床资料。结果本病多见于老年人(平均年龄62岁)，原发病灶多位于左半结肠-和直肠上段(27／38，71．1％)，肿瘤近侧结肠及盲肠穿孔占81．6％(31／38)，肿瘤部位穿孔占18．4％(7／38)，术前正确诊断率仅15．8％(6／38)，术后并发症多而严重，围手术期死亡率为42．1％(16／38)，死亡原因均为多器官功能衰竭，手术早晚与围手术期死亡率有密切关系。术后复发率为41．2％(7／17)，5年生存率为23．5％(4／17)。结论及时诊断、早期手术和防治多器官功能衰竭是降低本病死亡率的关键。

Diagnosis and Treatment of Acute Intestinal Perforation in Patients with Colorectal Carcinoma

Objective To investigate the clinical characteristics, diagnosis and treatment of acute intestinal perforation in the patients with colorectal carcinoma. Methods The clinical data of 38 colorectal carcinomas complicated with acute intestinal perforation treated in our hospital during 19 years were analyzed retrospectively. Results Acute intestinal perforation was common in old patients with colorectal carcinoma (mean age 62 years).The primary lesions were mostly located in left-side colon and superior rectum(27/38,71.1%). The perforation in the proximal colon of tumor and cecum accounted for 81.6%(31/38), and in tumor site accounted for 18.4%(7/38). The correct rate of preoperative diagnosis was only 15.8%(6/38). The postoperative complications were common and severe. The perioperative mortality was 42.1%(16/38). All the causes of death were multiple organ function deficiency. There were close relations between perioperative mortality and operation time. The postoperative recurrent rate was 41.2%(7/17). Five-year survival rate was 23.5%(4/17). Conclusion Early diagnosis, early operation and active prevention and treatment of multiple organ function deficiency were key to decrease the mortality of the colorectal carcinoma patients with acute intestinal perforation.