结直肠癌性梗阻的外科治疗: 附108例报告

目的　探讨结直肠癌性梗阻的治疗原则。方法　回顾性分析 10年间我院收治的 10 8例结肠梗阻患者的临床资料和治疗方法 :右半结肠癌 3 0例中 2 8例行一期切除吻合 ,1例行姑息性手术 ,1例未手术。左半结肠和直肠癌 78例中行一期切除 ( 5 6例 ) (Ⅰ期或Ⅱ期吻合分别 3 2 ,2 4例 )或二期切除11例 ,6例行姑息性手术 ,5例未手术。结果　伴结肠梗阻的结直肠癌多见于Duke′sC和D期 ( 5 9例 )的中、低分化腺癌 ( 65例 )。手术并发症发生率为 2 7.3 % ( 2 6例 46例次 ) ,以感染性并发症为主 ( 3 5 /46) ,吻合口漏 4例。围手术期死亡率为 7.8%。手术治疗患者的 5年生存率为 2 8.4% ,未手术者 5年生存率为 0 % (P <0 .0 1)。肿瘤I期 ,II期切除 5年生存率分别为 3 3 .3 % ,9.0 % (P <0 .0 5 )。肿瘤一期切除后行一期 ,二期吻合手术的 5年生存率无显著性差异 (P >0 .0 5 )。结论　对伴结肠梗阻的结直肠癌 ,手术应及时并遵循个体化原则 ,创造条件 ,要力争一期手术切除肿瘤 ,解除梗阻 ,但切除后行I期或II期吻合对预后无影响。

Surgical treatment of obstructive coloretal cancer:a report of 108 cases

Objective To study the surgical treatment principles of obstructive colorectal cancer. Methods The clinical data of 108 cases of obstructive colorectal cancer treated in our hospital in recent 10 years were retrospectively analysed. Of 30 cases of right hemicolon cancer ,28 cases received primary hemicolectomy and anastomosis,1 underwere conversative operation,and 1 received non-operative treatment.In 78 patients with left hemicolon or rectal cancer,56 underwent primary resection ( primary and secondary anastomosis were performed on 32 and 24 cases, respectively), and 11 received two-stage resection;nonresectable cancer underwent by-pass procedures in 6 cases,and non-operative treatment in 5. Results Most obstructive colorectal cancer were moderate or poor differentiated adenocarcinoma (65 cases) and in Dukes C or D stages(59 cases) . Postoperative complications rate was 27.3%(26 cases,46 times),most were infective complications(35/46) including 4 cases of anastomotic leakage. Eight cases died during perioperative period. The 5-year survavil rate in operative and nonoperative cases was 28.4% and 0% respectively(P<0.01) ;and in cases underwent primary or secondary tumor resection was 33.3% and 9.0% respectively(P<0.05). The 5-year survival rate in cases underwent primary tumor resection. with one- or two-stage anastomosis was no significant difference(P>0.05). Conclusions The surgical treatment principles for patients with obstructive colorectal cancer is to remove the tumor and relief the obstruction by one-stage operation individually if possible.But one-or two-stage anastomosis after tumor resection seems to be no influence on the patients prognosis.