老年结肠癌致肠梗阻急诊一期左半结肠切除的疗效分析

目的探讨一期切除吻合术治疗左半结肠癌致急性肠梗阻的可行性和安全性。方法回顾性分析43例左半结肠癌致急性肠梗阻在不能术前行肠道准备的条件下,行急诊肿瘤切除一期肠吻合的病例资料。结果本组43例患者中发生切口感染5例,切口裂开3例,吻合口瘘1例。全部病例未出现围术期死亡,均痊愈出院。结论对老年左半结肠癌致急性肠梗阻患者采取一期切除吻合术,只要选择病例合适,完善术中及围术期处理,手术是可行和安全的。     

结肠癌急性梗阻的治疗体会

目的：总结结肠癌急性梗阻的治疗经验。方法：回顾性分析了我院10年中急诊手术的结肠癌梗阻47例。结果：右半结肠癌22例，其中一期切除吻合15例，分期手术3例，捷径手术2例，肠造口2例。左半结肠癌24例，其中一期切除吻合4例，Hartmanns手术8例，结肠次全切除2例，一期造口、二期肿瘤切除5例，单纯造口术5例，另1例同时性结肠多原发癌行结肠次全切除。切口感染率为10．6％，其中一期切除吻合为15．8％；一期切除吻合吻合口漏2例（10．5％）；围手术期死亡2例（4．3％）。结论：结肠癌急性梗阻，应在积极术前准备的同时，尽早手术。右半结肠癌梗阻应在充分肠减压的基础上行I期切除吻合，左半结肠癌梗阻应首选Hartmanns手术。     

双管引流预防结肠癌切除1期吻合口瘘效果观察

198 51 999年 ,我们对左半结肠癌并结肠梗阻 2 1 5例采用术中结肠灌洗、左半结肠切除吻合治疗 ,对其中1 30例术中采用肠腔内吻合口上下置双管引流法预防吻合口瘘 ,并与扩肛组对比 ,发现前者效果满意。1　对象和方法1 1　对象　左半结肠癌并梗阻 2 1 5例 ,男 1 33例 ,女82例 ;年龄 2 575岁 ,平均 51岁。术前均无法进行有效的肠道准备 ,无并发结肠坏死和穿孔。分为双管引流组 1 30例 ,扩肛组 85例。两组年龄、性别、病情、体质状况无显著差异。1 2　方法　本组均急诊行左半结肠切除Ⅰ期吻合 ,术中早期静脉滴注足量抗生素 ,排空小肠内容物 ,…     

左半结肠癌并急性梗阻一期切除吻合术42例

目的探讨左半结肠癌并急性梗阻一期切除吻合术可行性。方法回顾性分析42例左半结肠癌并急性梗阻一期切除吻合术的临床资料,所有病例均术中结肠灌洗,同时行预防性盲肠造瘘。结果 42例一期切除吻合术,无一例发生吻合口漏、腹腔感染等并发症。结论严格掌握手术适应证,积极术前准备,术中充分结肠灌洗,实行预防性盲肠造瘘,正确术后处理,左半结肠癌并急性梗阻一期切除吻合术是安全可行的。     

老年人结肠癌并急性肠梗阻86例外科处理分析

目的探讨老年人结肠癌并发急性肠梗阻的特点、诊断、外科处理方法与预后。方法回顾性分析我院2000年1月—2009年8月86例年龄>60岁的老年患者手术治疗的结肠癌并发急性肠梗阻病人的临床资料,其中一期切除吻合58例(右半结肠一期切除吻合39例,左半结肠一期切除吻合19例),分期手术19例(右半结肠4例,左半结肠15例),行Hartmann手术。肿瘤无法切除行单纯结肠造瘘和捷径手术9例。结果术后出现并发症8例,发生率为9.3%,其中切口感染3例,腹腔感染2例,肺部感染2例,感染性休克1例,1例死亡,病死率1.2%,85例痊愈出院。结论老年人结肠癌致肠梗阻的外科治疗要根据老年病人的具体情况选择合理的术式,准确的早期诊断,恰当的围术期处理,正确的手术方式的选择,是提高其预后的关键。     

腹腔镜下老年结直肠癌根治术（16例分析）

目的：探讨腹腔镜辅助下老年结直肠癌根治术安全性、可行性及短期疗效。方法：回顾性分析16例腹腔镜辅助下老年结直肠癌根治术患者的临床资料。结果：左半结肠癌6例,横结肠癌3例,右半结肠癌6例,行I期结肠癌切除吻合术11例,Hartmann手术3例,单纯近端结肠造瘘2例。无死亡病例,吻合口瘘0例。结论：腹腔镜辅助下老年结直肠癌根治术在正确掌握手术时机、合理选择手术方式、充分的术前评估、完善的围手术期处理下是安全可行的。     

大肠癌致肠梗阻的外科治疗

目的：探讨大肠癌致肠梗阻的治疗方式。方法：回顾性分析我院1988-01~2008-10收治的大肠癌致肠梗阻的临床资料。结果：本组均行手术治疗。行一期右半结肠切除、横结肠切除吻合术60例,癌肿位于脾曲、降结肠、乙状结肠者行一期左半结肠切除吻合术15例,Hartm ann手术41例,癌肿位于直肠者行一期切除吻合术3例,近端造瘘二期根治术3例,肿瘤无法切除行乙状结肠双腔造瘘术2例。结论：大肠癌致肠梗阻的外科治疗要根据病人的具体情况选择合理的术式。     

左半结肠癌并发肠梗阻Ⅰ期切除回结肠造瘘36例

左半结肠癌并发肠梗阻在临床上较为常见，如经禁饮食、胃肠减压、预防感染、抑制消化液分泌、营养支持、通便等非手术治疗，梗阻未解除需行手术治疗。2007年12月-2012年12月，我们采用左半结肠癌并发肠梗阻工期切除回结肠造瘘，治疗左半结肠癌并发急性肠梗阻36例，效果满意。现分析报告如下。     

大肠急诊手术的术式选择

大肠的急诊手术,无法行常规的肠道准备,其术式的选择不同于择期手术。我科自1980年以来行大肠急诊手术20例,现将其手术处理的的方法作扼要分析和讨论。 临床资料 本组20例,男11例,女9例。发病年龄15～82岁,其中50岁以上患者占55％。 病变部位及急诊手术原因:左半结肠14例,右半结肠3例,左:右为4.67:1。直肠3例。癌肿并急性完全性肠梗阻15例;结肠克隆氏病并完全性肠梗阻及穿孔各1例;结肠癌破溃穿孔2例;乙状结肠外伤破裂穿孔1例。 术式及结果:14例左半结肠病变中,7例行Ⅰ期切除吻合术(切口感染3例);3例行Ⅰ期病灶切除加造瘘,Ⅱ期手术闭瘘(切口感染1例),3例因癌肿晚期无法切除,仅行梗阻近端造瘘(1例死于中毒性休克);1例乙状结肠外     

结肠癌并急性梗阻的手术治疗方法改进探讨

目的：探讨结肠癌并急性肠梗阻的术式选择,方法：急诊手术治疗右半结肠癌并急性肠梗阻11例,行一期切降,端仙吻合;左半结肠癌并急性肠梗阻2例,术中施行减压灌洗,一期切除肿瘤吻合,肛门放置肛管,结果：手术均获成功,术后效果良好,术后并发症：1例切口感染。结论：右半结肠癌并急性肠梗阻行一期切除,端侧吻合,左半结肠癌并急性肠梗阻和如全身状况较好,肠壁血运良好,采用术中减压灌洗,主张一期切除吻合。     

Bowel obstruction following liver transplantation: clinical and ct findings in 48 cases with emphasis on internal hernia

PURPOSE: To review the incidence, cause, and radiologic findings of bowel obstruction in patients who have undergone orthotopic liver transplantation (OLT). MATERIALS AND METHODS: Retrospective review of 4,001 cases of OLT revealed 48 cases of bowel obstruction in 44 patients. Seventeen computed tomographic (CT) scans and seven barium-enhanced radiographs were reviewed to determine level and cause. Surgical proof was available in 45 cases, while three had characteristic clinical and radiographic features. RESULTS: Adhesions caused the obstruction in 19 cases in 16 patients; three had bowel ischemia. Internal hernias caused obstruction in 18 patients; all obstructions were transmesenteric or retroanastomotic and occurred with choledochoenteric anastomosis. Seven patients had volvulus; four had bowel ischemia. CT signs of internal hernia included mesenteric vascular abnormalities and clusters of dilated small-bowel segments that displaced the colon away from the abdominal wall. Prospective diagnosis of internal hernia was made in only one case. Incisional or inguinal hernia caused obstruction in seven patients; CT was used just once. Four patients had neoplastic bowel obstruction, three due to posttransplantation lymphoproliferative disorder and one due to colon carcinoma. CONCLUSION: Liver transplantation was complicated by bowel obstruction in 48 (1.2%) of 4,001 cases. While adhesions and incisional hernias are common and well recognized, other causes are more challenging to diagnose. The CT findings reported here may allow more accurate diagnosis of internal hernia.     

Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation

PURPOSE: To determine the effectiveness and safety of metallic stents in the treatment of malignant colorectal obstruction before surgery and for palliation. MATERIALS AND METHODS: Eighty patients with acute malignant colorectal obstruction presumed to be malignant were treated by means of implanting self-expanding metallic stents. RESULTS: Stent placement was successful in 70 of the 80 patients and resolved bowel obstruction in 67 patients (96%). Two patients had colonic perforation and developed peritonitis 18 and 24 hours after stent placement; one patient died as a consequence. Thirty-three patients underwent elective surgery after 7 days +/- 3 (SD; range, 4-10 days), and adequate tumoral coverage and cleansing of the colon were observed in all patients. Stent placement was used as final palliative treatment in another 35 patients. Patient follow-up lasted a mean of 138 days +/- 93 (range, 36-334 days). The survival rate for the palliative group was 55% at 3 months, 44% at 6 months, and 25% at 9 months. The estimated primary stent patency rate was 91% at 3 and 6 months. CONCLUSION: Management of colorectal obstruction by using metallic stents was effective and safe, although colonic perforation is a potential complication. In cases of palliation, the method may obviate palliative colostomy.     

Colorectal Stenting: An Effective Therapy for Preoperative and Palliative Treatment

Purpose To demonstrate the effectiveness of preoperative and palliative colorectal stent placement in acute colonic obstruction. Methods Sixty-seven consecutive patients (mean age 67.3 years, range 25–93 years) with clinical and radiological signs of colonic obstruction were treated: 45 (67%) preoperatively and 22 (33%) with a palliative intent. In 59 patients (88%) the obstruction was malignant, while in 8 (12%) it was benign. A total of 73 enteric Wallstents were implanted under combined fluoroscopic/endoscopic guidance. Results Forty-five patients were treated preoperatively with a technical success rate of 84%, a clinical success rate of 83%, and a complication rate of 16%. Of the 38 patients who were successfully stented preoperatively, 36 (95%) underwent surgery 2–22 days (mean 7.2 days) after stent insertion. The improved general condition and adequate bowel cleansing allowed single-stage tumor resection and primary end-to-end anastomosis without complications in 31 cases (86% of all operations), while only 5 patients had colostomies. Stent placement was used as the final palliative treatment in 22 patients. The technical success rate was 95%, the clinical success rate 72%, and the complication rate relatively high at 67%, caused by reocclusion in most cases. After noninvasive secondary interventions (e.g., tube placement, second stenting, balloon dilatation) the secondary patency of stents was 71% and mean reported survival time after stent insertion was 92 days (range 10–285 days). Conclusion Preoperative stent placement in acute colonic obstruction is minimally invasive and allows an elective one-stage surgery in most cases. Stent placement also proved a valuable alternative to avoid colostomy in palliation.     

Value of the small bowel feces sign at CT in adhesive small bowel obstruction

PURPOSE: The purpose of this study is to describe the CT features of the small bowel feces sign and to determine its value as a positive criteria of non-severity in adhesive small bowel obstruction. MATERIALS AND METHODS: We performed a retrospective study of adhesive small bowel obstructions diagnosed by CT from January 2001 to December 2002. All CT examinations featuring a small bowel feces sign were included. Clinical follow-up was available for all included patients. RESULTS: Twenty patients were included in this study. Twelve patients underwent successful conservative treatment with nasogastric aspiration. Urgent laparotomy performed in 6 cases and delayed surgical intervention performed in 3 did not show ischemic complication. Surgical management always consisted in lysis of adhesions without intestinal resection. CONCLUSION: Recently described in the radiological literature, the small bowel feces sign appears to be the first criteria of non-severity in adhesive small bowel obstruction.     

CT features of primary colorectal signet-ring cell carcinoma

PURPOSE: The purpose of this work was to evaluate the CT features of 15 patients with primary colorectal signet-ring cell carcinomas. METHOD: We retrospectively reviewed the CT scans of 15 patients (mean age 44 years) with pathologically proved colorectal signet-ring cell carcinoma. On CT, we evaluated the site and length of the tumor, bowel wall thickening patterns, perirectal or pericolic infiltration, the presence or absence of colonic obstruction, and metastasis to other organs. RESULTS: The tumors were located in the rectum in nine patients, the sigmoid colon in one, the hepatic flexure in one, the transverse colon in one, the ascending colon in two, and the cecum in one. The tumor length ranged from 4.0 to 10.0 cm (mean 6.1 cm) with mean thickness of 2.1 cm. CT showed concentric bowel wall thickening in all patients ("even" in 8 and "uneven" in 7), target appearance was noted in 4, perirectal or pericolic infiltrations were moderate to severe in 12, and colorectal obstruction was seen in 6. In the tumor spread patterns, lymphadenopathy was noted in 13, invasion to adjacent pelvic organs in 5, peritoneal carcinomatosis in 4, liver metastasis in 2, and periureteric metastasis in 1. CONCLUSION: Primary signet-ring cell colorectal carcinoma should be included for differential consideration when CT shows a long length of concentric bowel wall thickening and target sign, especially when such findings occur in the rectum and in young patients.     

结直肠癌合并肠梗阻手术治疗118例临床分析

目的探讨结直肠癌合并肠梗阻的手术治疗方法。方法回顾性总结了118例结直肠癌合并肠梗阻患者的手术处理方法和治疗效果。结果右半结肠梗阻38例,36例行一期切除吻合,2例行回肠造口术;其余80例低位梗阻患者中53例行一期切除吻合,10例行Mile’s术,8例行Hartmann术,9例行结肠造口术,术后低位梗阻一期切除吻合43例患者中4例出现吻合口瘘,10例Dixon+横结肠造口术者未出现吻合口瘘。死亡2例。结论一定条件下,一期切除吻合是治疗结直肠癌并急性肠梗阻可行、有效的方法。顺行结肠灌洗可提高一期根治切除率。直肠癌行Dixon+横结肠预防造口术是值得借鉴的手术方式。     

Phase II Study of Percutaneous Transesophageal Gastrotubing for Patients with Malignant Gastrointestinal Obstruction; JIVROSG-0205

PurposeThis multicenter, prospective study was conducted to evaluate the efficacy of percutaneous transesophageal gastrotubing (PTEG) as an esophagostomy procedure for bowel decompression in patients with malignant bowel obstruction.Materials and MethodsThe study subjects were patients with malignant bowel obstruction treated with a nasogastric tube (NGT). After receiving PTEG, efficacy evaluations were conducted, with NGT designated as the control state. The procedure was considered effective only when discomfort in the nasopharynx was improved for at least 2 weeks. Safety was evaluated by using National Cancer Institute Common Toxicity Criteria, version 2.0. PTEG was performed by using a PTEG kit.ResultsFrom February 2003 to December 2005, 33 patients were enrolled. The technical success rate was 100%, and the procedure was considered effective in 30 of 33 cases. The three cases in which the procedure was ineffective could not be evaluated as a result of deterioration of general status or early death. The one recorded complication was a tracheoesophageal fistula that caused grade 2 aspiration pneumonia.ConclusionsPTEG is an effective technique to relieve discomfort in the nasopharynx caused by NGT in patients with terminal malignant tumors. PTEG should be considered an efficacious method for bowel decompression in patients who are ineligible for surgical procedures, percutaneous gastrostomy, or percutaneous enterostomy.     

暂时性金属内支架治疗结肠梗阻和对手术方式的影响

目的探讨在X线透视下经内镜引导置入暂时性金属内支架缓解结肠梗阻的方法和临床应用价值。方法33例结、直肠癌引起肠梗阻的患者,在X透视下经内镜引导在梗阻部位行暂时性金属内支架置入术。结果27例成功置入金属内支架后24～48h肠梗阻症状缓解,经肠道准备后均作了选择性Ⅰ期结肠癌切除吻合术。支架置入成功率81．8％。结论暂时性金属内支架可有效的缓解结、直肠癌引起的梗阻,在X透视下经内镜引导能提高支架置入成功率从而使梗阻患者的结肠癌能得到Ⅰ期切除结肠吻合。