结直肠癌并急性肠梗阻的外科治疗(附129例临床分析)

目的探讨结直肠癌并急性肠梗阻的外科治疗原则和方法。方法回顾性分析我院1995年1月-2005年1月收治的129例合并急性肠梗阻的结直肠癌病例。在42例右半结肠癌患者中，一期行切除吻合术37例，5例因广泛转移而仅行造瘘术；在87例左半结肠癌和直肠癌患者中，68例一期行Hartmann术、二期行闭瘘吻合术，6例行一期切除吻合术，2例行乙状结肠切除吻合加横结肠造口术，3例行肿瘤切除永久性横结肠或乙状结肠造口术，8例行姑息性单纯结肠造口术。结果术中出现并发症29例(22．5％)，其中切口感染11例，切口裂开3例，肺部、腹腔、泌尿系感染各1例，心、肺、肾功能不全9例，感染性休克1例，循环功能不全1例、肺栓塞1例，后3例死亡(2．3％)，其余痊愈出院，无一例发生吻合口瘘。结论结直肠癌合并急性肠梗阻多属中晚期，手术是解除梗阻的有效方法，术式选择应根据病变部位和病情而定，做好围手术期处理是减少并发症、降低病死率的关键。

Surgical Treatment of Colorectal Carcinoma Associated with Acute Intestinal Obstruction ( with a Reportof129 Cases)

Objective To investigate the surgical treatment and surgical principles of colorectal carcinoma associated with acute intestinal obstruction. Method 129 cases of colorectal carcinoma associated with acute intestinal obstruction from January 1995 to January 2005 were retrospectively reviewed. Within the 42 cases of right hemi-colonic carcinoma, primary resection and anatomosis were performed in 37 cases, colostomy were performed in 5 cases due to extensive metastasis; within 87 cases of left hemi-colonic carcinoma and rectal carcinoma, Hartmann operation and secondary anatomosis performed in 68 cases, primary resection and anatomists performed in 6 cases, sigmoid colonectomy and anastomosis associated with transverse colostomy performed in 2 cases, tumor resection and permanent transverse or sigmoid colostomy performed in 3 cases, palliative colostomy performed in 8 cases. Result Complications occurred in 29 cases (22.5%), including wound infection in 11 cases, disruption of wound in 3 cases, pulmonary, abdominal cavity and urinary infection in 1 case for each, cardiac, pulmonary and renal function failure in 9 cases, there were 3 death due to circulation dysfunction in 1 case, pulmonary emboli in 1 case and septic shock in 1 case. No anastomotic leakage occurred. Conclusion Acute intestinal obstruction indicate advanced stage of colorectal carcinoma, operation is the only approach to resolve the obstruction, and different tumor site and general condition determine different procedure, intensive perioperative treatment is essential to reduce complication and mortality.