右半结肠肿瘤侵犯十二指肠的外科治疗

目的探讨右半结肠肿瘤侵犯十二指肠的外科处理方法及疗效。方法右半结肠肿瘤侵犯十二指肠患者26例,根据肿瘤浸润十二指肠程度,行十二指肠局部切除后直接修补6例、带蒂补片十二指肠浆肌层修补7例、扩大胰头十二指肠联合切除5例和姑息性手术8例。结果 6例十二指肠局部切除后直接修补者,1例术后发生修补处狭窄;7例带蒂补片修补十二指肠缺损者中,6例采用带蒂回肠瓣修补,1例采用胃浆肌层瓣修补,其中1例带蒂回肠瓣修补患者术后发生十二指肠修补处漏,经充分引流后痊愈,1例胃浆肌层瓣修补患者术后发生胃梗阻,2周后加作胃空肠吻合后康复;5例扩大胰头十二指肠联合切除者,1例围手术期因呼吸衰竭死亡;8例姑息性手术包括4例回肠横结肠侧侧吻合和4例十二指肠浸润旷置的结肠姑息性切除。结论合理的术式选择和积极的外科处理将有助于改善结肠肿瘤侵犯十二指肠患者的症状和预后。

Surgical Management for Right-colon Neoplasma Invading Duodenum

Objective To explore the surgical management for right-colon carcinoma with duodenal invasion.Methods Twenty-six patients demonstrating right-colon carcinoma directly invading the duodenum was presented.Different surgical management strategies were selected based on the duodenal involvement.Results Right hemicolectomy with partial duodenectomy and primary closure of the duodenal wall defect was performed in six cases,and postoperative duodenal stenosis in anastomotic site was found in one case.A pedicled patch to repair large duodenal defect after right hemicolectomy was carried in 7 cases,including a pedicled ileal patch in 6 and a pedicled gastric flap in 1 case.Postoperative duodenal leakage was found in one patient with a pedicled ileal patch and recovered after drainage.The patient with a pedicled gastric flap was found postoperative gastric obstruction,and was resolved by gastroenteroanastomosis side by side two weeks after operation.Of 5 patients subjected to right hemicolectomy with pancreaticoduodenectomy,one postoperative death was caused by lung failure.Palliative operation was performed in 8 cases,including ileotransverses colostomy in 4 and palliative hemicolectomy in 4 cases.Conclusions Duodenal invasion by a right-sided colon neoplasm does not necessarily represent incurable disease.If preoperative preparation is carefully applied based on the extent of duodenal invasion,active surgical management is very useful for improving patients＇ prognosis without increasing the risks associated with surgery.