结肠癌侵犯十二指肠的手术方式探讨

目的探讨结肠癌侵犯十二指肠的手术方式，评估临床疗效。 方法回顾性分析第四军医大学附属西京医院2013年1月至2014年12月收治的结肠癌侵犯十二指肠患者共26例，结合患者不同的临床特点及手术方式进行生存分析。 结果根治性右半结肠切除术8例，根治性右半结肠切除术+十二指肠壁缺损间断全层缝合术10例，右半结肠切除、空肠十二指肠端侧吻合+空肠Roux-en-Y吻合、空肠营养管造瘘术4例，右半结肠切除、胰十二指肠切除术1例，根治性右半结肠切除、胃窦及球部切除、胃空肠吻合术1例，横结肠-回肠侧侧吻合术2例。术后除1例发生横结肠回肠吻合口瘘，未发生十二指肠瘘、胰瘘等严重并发症，12个月生存率84.6%，30个月生存率76.9%。 结论结肠癌侵犯十二指肠时，术前影像学评估、合理的手术方式选择和积极的外科处理将有助于减少术后并发症，提高临床疗效，改善预后。

Operation approaches for colon cancer invading duodenum

ObjectiveTo investigate the operation approaches of colon cancer invading duodenum and to evaluate the clinical effect. MethodsA retrospective analysis of twenty six cases of colorectal cancer patients admitted to Xijing Hospital from January 2013 to December 2014 were analyzed according to different clinical features, surgical methods and the survival of the patients. ResultsRadical right hemicolectomy was carried out in 8 cases, the radical right hemicolectomy resection combined with duodenal wall defect discontinuous full-thickness suture in 10 cases, and 4 cases underwent right hemicolectomy, duodenum jejunum end to side anastomosis+ jejunum Roux-en-Y anastomosis, jejunum nutrition tube fistulation. 1 patient underwent right hemicolectomy, pancreas duodenum to intestinal resection, radical resection, resection of the gastric antrum and duodenal bulb, and 1 case of gastrojejunal anastomosis of the colon. The other 2 cases were given transverse colon and ileum side to side anastomosis. 1 patient had postoperative colon ileum anastomotic fistula. 12-month survival rate was 84.6%, and 30-month survival rate was 76.9%. ConclusionReasonable imaging evaluation, aggressive surgical treatment combined with the right surgical methods can improve the prognosis of patients with colon cancer invading duodenum.