右半结肠癌切除合并十二指肠缺损的处理

目的探讨右半结肠癌切除十二指肠缺损的外科处理方法。方法1990年1月~2004年1月收治右半结肠癌切除合并十二指肠缺损10例,根据缺损的程度总结为局部小缺损、巨大缺损和内瘘型缺损三种类型。采用局部切除间断缝合十二指肠局部小缺损4例;带蒂末端回肠补片修补十二指肠巨大缺损2例;内瘘型的4例分别行局部修补、十二指肠引流1例,带蒂胃壁浆肌层补片修补、十二指肠造口1例,右半结肠切除后加行胰十二指肠切除2例。结果内瘘型缺损中,行带蒂胃壁浆肌层补片修补、十二指肠造口的1例术后并发胃梗阻,2周后加作胃空肠吻合后恢复出院,行十二指肠引流的1例术后出现十二指肠漏,后因病情恶化出院,其余8例无围手术期并发症,顺利恢复。结论根据右半结肠癌切除十二指肠缺损的不同特点,积极合理的手术抉择和外科处理将有助于改善预后和减少手术风险。

Surgical Management for Duodenal Invasion of Right Side Colonic Cancer

Objective To investigate the surgical treatment for duodenal invasion of right side colonic cancer. Method 10 cases of duodenal invasion of right side colonic cancer were surgical treated, the defect of duodenal wall after resection were stratified in 3 types as minor, major and internal fistula related. 4 cases of minor type underwent wedge resection and interrupted suture repair, vascularized terminal ileum flap repair were applied in 2 cases of major type. For the 4 cases of internal fistula type, the procedure including the fistula repair and duodenal decompression in 1 case, pedicled gastric wall flap repair and duodenostomy in 1 case, and right hemi-colonectomy in combination with pancreatoduodenectomy in 2 cases. Result Gastric obstruction occurred in the case who undergone gastric flap repair and cured by gastrojejunostomy 2 weeks later, a case developed duodenal fistula and discharged without follow-up. The rest 8 cases recovered uneventfully. Conclusion Variety of surgical treatment can be selected based upon the detailed circumstance, leading a way to improve the prognosis and reduce risk.