32例急腹症表现的结直肠癌外科治疗体会

目的 探讨急腹症表现的结肠癌手术的术式选择对预后的影响及和并发症发生的关系.方法 回顾性分析2005年1月至2012年12月丹阳市中医院普外科收治的32例急腹症表现的结肠癌病人的临床资料.结果 32例患者中肠梗阻表现的结肠癌18例,肠穿孔表现10例,阑尾炎表现4例.32例均行手术治疗,26例急诊手术,6例限期手术.一期肿瘤切除吻合者29例,其中行预防性造瘘者2例,余3例肿瘤无法切除仅做单纯肠造瘘术.无术中死亡病例,29例一期肿瘤切除吻合者中仅1例出现吻合口瘘、腹腔感染、营养不良,最终死于MODS,余28例未出现吻合口瘘,3例切口感染,3例单纯肠造瘘者无相关手术后并发症发生.结论 急腹症表现的结肠癌大部分行一期肿瘤切除吻合是可行的,预防性造瘘对减少术后吻合口瘘是有效的,正确的术中术后处理对改善预后、降低术后并发症发生率是重要的.

Experience of surgical treatment for colorectal cancer which had acute abdomen manifestation

Objective To investigate the effects of operation selection on prognosis and occurrence of complications for patients suffered from colon cancer and had acute abdomen manifestation. Methods Retrospectively analysis the clinical data of 32 patients those who suffered from colon cancer combined with acute abdomen and received surgery in Department of general surgery of Danyang Traditional Chinese Medicine Hospital from January 2005 to December 2012. Results In all the 32 colon cancer patients, 18 of them present intestinal obstruction, l 0 performed intestinal perforation, 4 cases of appendicitis. All patients received surgery, 26 of them received emergency surgery, 6 got deadline surgery. Phase I tumor resection and anastomosis in 29 cases, including prophylactic fistula for 2 patients, 3 patients only received enterostomy without tumor resect, and had no related complications after surgery. None intra-operative death occurred, 1 patient in 29 died of MODS, anastomotic leakage didt appear in the last 28 cases, but wound infection occurred in three of them. Conclusions Resection of colon cancer and phase one anastomosis was feasible for colon cancer manifest acute abdomen, preventive colostomy is effective to reduce the incidence of anastomotic leakage, correct intra-operative and postoperative treatment was important to improve the prognosis and reduce the incidence of postoperative complications.