急性肿瘤性结肠梗阻的治疗

目的:探讨急性肿瘤性结直肠梗阻的外科处理原则和方法。方法:回顾性分析103例急性肿瘤性结肠梗阻患者的临床资料。结果:全部患者经手术治疗，包括急诊手术80例，其中右半结肠癌25例均行一期切除吻合手术，左半结肠癌45例中一期切除吻合37例，直肠癌10例，均行急诊手术。择期性手术23例。术后发生吻合口瘘3例，肺部感染2例，盆腔感染1例，死亡1例，余均治愈出院。 结论:对于急性肿瘤性结肠梗阻除非有急诊手术指征，应首先采用非手术治疗1～3d，尽可能转为择期性手术；只要恰当掌握适应证，一期肿瘤切除吻合术是比较安全的；对于腹腔污染严重、肠壁穿孔，也应尽可能采用一期切除肿瘤。

The treatment of acute neoplastic colorectal obstruction

Objective To explore the principles and methods of surgcal treatment for acute neoplastic colorectal obstruction. Methods The clinical data of 103 patients diagnosed as acute neoplastic colorectal obstruction were analyzed retrospectively, Results In this group, 80 cases underwent emergency surgical treatment, among which, 25 cases of carcinoma of right colon underwent primary resection and anastomosis ; in 45 cases of carcinoma of left colon, primary resection and anastomosis was performed in 37 cases; and emergent operations were performed in 10 cases of rectal cancer. 23 cases received non-emergency surgery. Anastomotic fistula occurred in 3 patients, pulmonary infection in 2 patients, pelvic cavity infection in 1 patient, 1 patient died and the rest recovered well and were discharged. Conclusions The initial treatment for acute neoplastic colorectal obstruction should be non-surgcal treatment for 1 - 3 d to make non-emergency surgical treatment more possible. If indications are properly selected, primary tumor resection and anastomosis is safe. For patients with severe contamination of abdominal cavity and bowel perforation, primary tumor resection should be performed if possible.