癌性急性结肠梗阻的诊断及术式选择

目的：探讨癌性急性结肠梗阻的诊断及术式选择。方法：回顾分析经手术治疗的78例临床资料。结果：本组占同期急性结肠梗阻总数的73.6%（78/106）,术前确诊率78.2%（61/78）,Ⅰ期肿瘤切除62例,占79.5%（62/78）,Ⅰ期吻合49例,占79%（49/62）;其中左半结肠癌占67.3%（33/78）,Hartmann手术13例。Ⅰ期单纯造瘘14例（6例Ⅱ期切除）,总切除率87.1%（68/78）。术后并发吻合口瘘1例,治愈76例,死亡2例（2.6%）。结论：加强癌性急性结肠梗阻的术前诊断和认识;按解除梗阻争取切除肿瘤为第一,吻合为第二,治疗个体化的原则选择术式。

Diagnosis and operative procedure choice of carcinomatous acute colonic obstruction

Objective:To investigate the diagnosis and operation choosing of carcinomatous acute colonic obstruction(CACO).Methods:Tthe clinical data of operative treatment in 78 cases of CACO from Jan 2000 to Dec 2006 were restrspectively analyzed.Results:This group accounted for 73.6% of all acute colonic obstruction(ACO)in the same term.The pre-operative diagnosis rate of CACO was 78.2%(61/78).62 patients(79.5%)underwent one-stage tumour resection,of which 49 patients(79%)underwent primary anastomosis including 33 cases in left colonic carcinoma(67.3%),13 patients underwent Hartmann procedure,first-stage simple colostomy in 14 cases,second-stage resection 6 cases.The overall resection rate was 87.1%.Anastomotic leakage was found of 1 case,recovery 76 cases,death 2 cases(2.6%).Conclusion:To enhance pre-operation diagnosis and recognition of CACO.the principle of operation choosing is releasing obstruction and cutting off the tumour the first,anastomosis the second,and individuated management.