右半结肠癌合并肠梗阻的外科诊治

目的探讨右半结肠癌致肠梗阻的诊断及外科手术治疗方法。方法回顾性分析1997年1月至2006年12月间56例右半结肠癌致肠梗阻外科手术治疗资料。结果56例患者中，不完全性肠梗阻41例，完全性肠梗阻15例；肿瘤位于回盲瓣处21例，位于结肠肝曲35例；同时伴有腹部肿块16例，伴有贫血28例；肿块型23例，溃疡性33例；Dukes分期：C期50例，D期6例。56例患者均行右半结肠切除术，横结肠回肠端端一期吻合术，同时行肝脏肿瘤切除术3例，十二指肠部分切除修补术3例。无一例出现吻合口瘘。术后死亡2例，围术期病死率3．6％。术后出现腹部并发症9例，并发症发生率16．1％，均经保守治疗治愈。结论重视右半结肠癌所致肠梗阻是早期诊断、早期手术治疗原因不明肠梗阻的重要保证。

Diagnosis and therapy of the right - colonic obstruction caused by malignancies

Objective To discuss the diagnosis and treatment of right - colonic obstruction caused by malignancies. Methods A retrospective study was adopted to analyze the clinical date of 56 patients of fight - colonic obstruction caused by malignancies. Results Among all the patients, 41 cases were incomplete intestinal obstruction, 15 cases were complete intestinal obstruction; 21 cases were ileceeal valve cancer, 35 cases were ileeecal hepatic flexure colon cancer; 16 cases had the simultaneous phenomenon of abdominal tumor, 28 cases had the simultaneous phenomenon of anaemia ; 50 cases were during the period of Dukes C, 6 cases were during the period of Dukes D. Right hemicolectomy was carried out in all 56 cases and partial hepatectomy carried out in 3 cases and partial duodenectomy carried out in 3 cases simultaneously. None of anastomotic leak happen. 2 cases died post operation, and perioperative death rate was 3.6%. Post operative abdominal complications oceured in 9 cases and post operative com- plication rate was 16.1%. All complications were cured by conservative therapy. Conclusions Paying attention to obstruction caused by right - colonic cancer is important assurance measure of early diagnosing and treating noncausal intestinal obstruction.