结肠癌伴发急性梗阻的诊断及外科治疗

目的探讨结肠癌伴发急性梗阻的术前诊断和外科治疗问题。方法复习近年有关文献,结合我科近6年中治疗的结肠癌伴梗阻病例的临床资料,对其术前诊断检查和治疗过程进行回顾性分析和总结。结果36例中50岁以上占27冽。右半结肠癌伴急性梗阻16例,左半结肠癌伴急性梗阻20例。本组绝大多数术前确诊靠腹部X线平片和钡剂灌肠。有35例根据肿瘤发生的部位作了Ⅰ期肺切除吻合术,无吻合口瘘的发生。结论对疑为结肠癌引起梗阻的病人,在术前诊断检查上应首选X线腹部平片和钡剂灌肠检查。尽管在急性梗阻时行Ⅰ期结肠切除吻合有发生吻合口疾的危险,但只要掌握好手术适应症,处理好手术的各个环节,Ⅰ期结肠切除吻合术是安全可行的。     

一期肠切除吻合术治疗左半结肠癌急性肠梗阻的体会

目的 探讨左半结肠癌急性梗阻一期切除吻合术的可行性.方法 回顾分析33例左半结肠癌急性梗阻行Ⅰ期切除吻合术的适应证及术中、术后处理方法.结果 本组病例全部行一期肠切除吻合.术后切口感染3例,吻合口漏1例,无手术死亡病例.结论 只要病例选择得当,术前、术中和术后得到正确处理,左半结肠癌急性梗阻一期手术切除吻合是安全可行的.     

急性梗阻性左半结肠癌I期切除吻合59例治疗分析

目的:探讨左半结肠癌并急性梗阻行I期切除吻合术的安全性和可行性.方法: 回顾性分析59例急性梗阻性左半结肠癌手术治疗患者的临床资料.结果: 结肠脾曲癌11例,降结肠癌34例,乙状结肠癌14例,行I期结肠癌切除吻合术53例,Hartmann手术3例,单纯近端结肠造瘘3例.无死亡病例,吻合口瘘2例.结论: 正确掌握急性梗阻性左半结肠癌手术时机、灌洗方法,合理选择手术方式,做好围手术期处理,尽量选择I期切除吻合术是安全可行的.     

急性梗阻性左半结肠癌I期切除吻合59例治疗分析

目的：探讨左半结肠癌并急性梗阻行I期切除吻合术的安全性和可行性。方法：回顾性分析59例急性梗阻性左半结肠癌手术治疗患者的临床资料。结果：结肠脾曲癌11例,降结肠癌34例,乙状结肠癌14例,行I期结肠癌切除吻合术53例,Hartmann手术3例,单纯近端结肠造瘘3例。无死亡病例,吻合口瘘2例。结论：正确掌握急性梗阻性左半结肠癌手术时机、灌洗方法,合理选择手术方式,做好围手术期处理,尽量选择I期切除吻合术是安全可行的。     

梗阻性大肠癌的急诊处理(附138例分析)

目的　探讨结肠癌急性梗阻的诊断和手术方式选择。方法　回顾分析我院 1986— 2 0 0 0年 13 8例梗阻性结直肠癌病人的临床特点及治疗方法。对梗阻性左半结肠癌 ,术中行顺行结肠灌洗或次全结肠切除 ,Ⅰ期切除吻合术 98例 ( 70 %) ,分期手术 2 2例( 16%) ,Miles及Hartmann术 12例。其他手术 10例。结果　手术死亡率为 8.7%( 12 / 13 8) ,吻合口漏发生率 4.5 %,切口感染率 16.2 %,其余病人恢复顺利。结论　对于梗阻性左半结肠癌 ,术中灌洗Ⅰ期吻合和结肠次全切除都是可供选择的方法 ,但应依据病人全身情况和肿瘤局部条件实施     

梗阻性大肠癌的急诊处理（附138例分析）

目的探讨结肠癌急性梗阻的诊断和手术方式选择。方法回顾分析我院1986—2000年138例梗阻性结直肠癌病人的临床特点及冶疗方法。对梗阻性左半结肠癌，术中行顺行结肠灌洗或次全结肠切除，Ⅰ期切除吻合术98例(70％)，分期手术22例(16％)，Miles及Hartmann术12例。其他手术10例。结果手术死亡率为8．7％(12／138)，吻合口漏发生率4．5％，切口感染率16．2％，其余病人恢复顺利。结论对于梗阻性左半结肠癌，术中灌洗Ⅰ期吻合和结肠次全切除都是可供选择的方法，但应依据病人全身情况和肿瘤局部条件实施。     

结肠癌合并不全梗阻34例外科治疗

目的探讨结肠癌合并不全梗阻行Ⅰ期手术切除吻合的可行性.方法回顾分析了1995至2004年收治的结肠癌合并不全梗阻行Ⅰ期手术切除吻合34例的临床资料,30例行Ⅰ期肠吻合.结果本组行Ⅰ期结肠切除吻合28例,单纯回肠横结肠吻合捷径手术2例,除1例乙状结肠切除吻合术后发生吻合口瘘经保守治愈以外,均无吻合口瘘等并发症.结论对于左半结肠癌引起的梗阻,行Ⅰ期切除吻合目前争议较大,我们认为对于梗阻时间短,梗阻程度不重,全身中毒症状较轻,肠膨胀与炎症不明显者,可以采取Ⅰ期切除吻合.     

左半结肠癌并梗阻—期切除吻合46例报告

对46例左半结肠癌并梗阻患者的治疗进行回顾性分析,46例肿瘤位于左半横结肠7例,脾区9例,降结肠12例,乙状结肠18例,术中行结肠减压、顺行结肠灌注,根治手术切除36例,姑息性切除10例,均行吻合口一期吻合.结果切口感染6例,2例发生吻合口瘘,经手术治疗痊愈,无手术死亡.结果提示,一期切除吻合术在急性梗阻性左半结肠癌中的应用是安全可行的.     

左半结肠癌并肠梗阻手术治疗体会

目的 探讨左半结肠癌梗阻的手术治疗方法.方法 对我院58例左半结肠癌梗阻手术治疗结果进行回顾性分析.结果 56例痊愈出院,2例放弃继续治疗,无病例住院死亡,无吻合口瘘发生.结论 只要正确掌握手术适应证,细致手术操作,重视围手术期处理,左半结肠癌并肠梗阻Ⅰ期切除吻合术安全、可靠.     

左半结肠癌并梗阻一期切除吻合46例报告

对 46例左半结肠癌并梗阻患者的治疗进行回顾性分析 ,46例肿瘤位于左半横结肠 7例 ,脾区 9例 ,降结肠 12例 ,乙状结肠 18例 ,术中行结肠减压、顺行结肠灌注 ,根治手术切除 36例 ,姑息性切除 10例 ,均行吻合口一期吻合。结果 :切口感染 6例 ,2例发生吻合口瘘 ,经手术治疗痊愈 ,无手术死亡。结果提示 ,一期切除吻合术在急性梗阻性左半结肠癌中的应用是安全可行的。     

结肠癌所致的急性肠梗阻：附33例报告

本文报告33例结肠癌所致急性肠梗阻的诊治体会.认为结肠癌是大肠梗阻的常见原因.无腹部手术史的老年患者肠梗阻应首先考虑结肠癌的可能性,腹透是常用而较简便的鉴别诊断方法之一.钡灌肠和纤维结肠镜应慎用,作者提倡在严格掌握指征的情况下争取行Ⅰ期吻合术.并对其适应症进行了讨论,本组25例行根治术加Ⅰ期吻合.无吻合口瘘发生。     

大肠癌并发急性肠梗阻手术治疗的探讨

目的　探讨大肠癌并发急性肠梗阻的手术治疗方法。方法　回顾性分析我院收治的大肠癌并发急性肠梗阻 5 6例 ,结合国内外文献 ,综合评价手术治疗方法。结果　本组手术死亡率为 3 6 % ,一期左半结肠切除吻合的吻合口瘘发生率为 5 5 %。结论　对左半结肠癌、直肠癌并发急性肠梗阻病人的治疗 ,掌握好适应证 ,施行一期切除吻合术是安全有效的     

Primary ileal carcinoma

Recently encountered is a case of a primary ileal carcinoma in which radical resection was performed. The history follows. A 76-year-old male was admitted to Miyako Hospital on January 12, 1986 complaining of abdominal pain of ten days duration. Pre-operative treatment extended over an eleven-day period without any symptomatic remission. A barium enema and roentgenographic examination that followed a barium ingestion revealed no abnormality in the large bowel, but a mechanical obstruction, typical of a carcinoma, was detected in the small intestine. On January 23, 1986, under a general anesthesia, the abdomen was opened through a midline rectus incision. A tumor was found in the terminal ileum 14 cm proximal to the ileocecal valve, and was causing almost total obstruction of the intestine. This tumor, with involved ileal and regional lymph-nodes, was resected, followed by an end-to-end anastomosis. The tumor, grossly circumscribed, was roughly circular in outline and protruded from the ileal wall. No lymph-node metastasis was found in histological sections. The diagnosis was a primary adenocarcinoma of the ileum. Few reports have been reported in Japan on radically resected primary carcinomas of the ileum. The future course of this case deserves careful study.     

A case report of early rectal carcinoma, IIa + IIc type, with no invasion of the submucosa

A 66-year-old woman was admitted to the Hakodate Chuo Hospital because of abdominal discomfort. A barium enema study revealed a deformity of the middle Houston's valve of the rectum and granular lesions at the Rb region of the rectum. A colonoscopic examination showed the IIa + IIc type of early rectal carcinoma. A resected specimen also revealed IIa + IIc type early rectal carcinoma, 8 X 13 mm in diameter, and well-differentiated adenocarcinoma with no invasion of the submucosa. Infiltration into the lymphatic vessels and regional lymph node metastasis were not encountered. The deformity of the rectal Houston's valve was checked by a barium enema study. It should be emphasized that early detection of colorectal carcinoma with no invasion of the submucosa, requires careful barium enema studies and colonoscopic examination.     

Multiple colorectal carcinoma and barium enema perforation

A patient with simultaneous metachronous carcinoma and polyps of the large bowel is presented. The importance of carcinoma as a predisposing cause to perforation during barium enema is stressed. In view of the considerable incidence of recurrent large bowel tumors, careful routine follow-up studies should be undertaken and extreme caution exercised during the barium enema.     

Barium Granuloma of the Rectum

Two cases of barium granuloma of the rectum diagnosed by rectal biopsy 26 months and 3 months after their last barium enema examinations are described. That a barium enema may require the patient to undergo a rectal biopsy at a later date to exclude carcinoma is a reminder of the constant care required in the performance of this examination.     

Radiology of Abdominal Tuberculosis

Radiological findings in 70 cases of abdominal tuberculosis are presented and their diagnostic value assessed. Evidence of tuberculosis was seen on chest X-ray in half of the cases while plain X-rays of the abdomen were positiye in thee-quarters of the cases. Chest X-rays and abdominal X-rays were positive respectively in 80% and 100% of the patients presenting with acute complications viz. obstruction, perforation and peritonitis. Barium studies were found to be of help in diagnosis (81%) although both false-positive and false-negative findings were observed. Ileocecal and colonic lesions were seen on barium enema whereas barium meal-follow through better demonstrated the lesions in the small intestine. Barium studies were, however, inadequate in detecting multiple lesions and often incorrect in indicating the site of the lesion. Diagnosis of abdominal tuberculosis is mainly clinical and is further strengthened by positive chest and abdominal X-rays. Barium studies corroborate the diagnosis when these X-rays are negative. Barium enema visualises the ileocecal and colonic lesions whereas the lesions in the small intestine are better demonstrated by barium meal follow through.     

同时多原发大肠癌与大肠腺瘤

本组１６６例大肠癌，发现同时多原发大肠癌８例（４．８％）。肿瘤分布广，但直、乙结肠占一半以上（５５．５％）。单发癌有２７．７％合并腺瘤，同时癌５０％合并腺瘤；４例合并腺瘤的同时癌有腺瘤１４处，其中２例３处癌变，癌变率为伴腺瘤的５０％。全组１８个癌灶中８个小于２ｃｍ，术前钡灌肠及术中探查均易漏诊。术前全结肠镜检查是提高诊断率的重要手段。     

Synchronous and metachronous colon lesions in squamous cell carcinoma of the anal canal

The charts of 79 patients with a histologic diagnosis of squamous cell carcinoma of the anal canal were reviewed to determine the incidence of synchronous and/or metachronous colon lesions. Forty-six patients underwent an adequate preoperative evaluation of the colon and rectum. Ten patients underwent colonoscopy, 33 patients underwent a barium enema, and three patients underwent colonoscopy and a barium enema. In this group six adenomatous polyps and three hyperplastic polyps were discovered. An adenocarcinoma of the sigmoid colon was found in another patient six months prior to the diagnosis of a squamous cell carcinoma of the anal canal. Twenty-three patients had follow-up evaluation of the large bowel for metachronous lesions following treatment of the squamous cell carcinoma of the anal canal. Ten patients underwent colonoscopy, three patients had a barium enema, and ten autopsies were available for analysis. In this group metachronous lesions consisted of two adenomatous polyps and one hyperplastic polyp.