急性结肠梗阻的诊断与治疗

目的　探讨急性结肠梗阻的诊断、围手术期处理及手术方式的选择。方法　回顾分析我院 1991年 1月至 1997年 11月间手术治疗的急性结肠梗阻 5 7例。结果　癌性结肠梗阻占 72 % ( 41/ 5 7) ,而术前确诊率仅 3 2 %( 13 / 41)。术前选用预防性抗生素静脉滴注 ,术中行肠减压及结肠灌洗 ,行一期切除手术 44例 ,占 77% ( 44 / 5 7) ,同时一期吻合 3 6例 ,占 82 % ( 3 6/ 44 ) ,其中左半结肠病变者占 5 6% ( 2 0 / 3 6) ,无死亡及吻合口瘘发生。结论　对急性结肠梗阻应加强术前诊断和认识 ,完善术前、术中处理是降低一期肠切除和吻合术后并发症和死亡率的关键

Diagnosis and management of acute obstruction of colon

Objective The purpose of this study was to evaluate the diagnosis,perioperative management and procedure′s choice of acute obstruction of colon (AOOC).Methods Fifty-seven cases of AOOC operated upon between Jan 1991 and Nov 1997 were reported,and related problems were discussed.Results There were 41 cases (72%,41/57) of acute carcinomatous colonic obstruction (ACCO) among them,but the preoperative diagnosis rate of ACCO was only 32% (13/41).Through protective antibiotic intravenation and on-table proximal decompression or/and lavage,44 patients (77%) underwent single-stage resection,of whom 36 patients (82%) underwent primary anastomosis including 20 cases of left colonic lesion.In this group,there were no deaths and leaks.Conclusion We believe that it is a key to the problem to enhance preoperative diagnosis,cognition and do well perioperative management of AOOC for reducing mortality and complication of single-stage resection and anastomosis.