腹腔内恶性肿瘤术后肠梗阻的治疗

目的:研究腹腔内恶性肿瘤术后肠梗阻的最佳治疗方法。方法:对我院自1994年8月～2002年7月八年间共收治的63例腹腔内恶性肿瘤术后肠梗阻进行回顾性研究。将63例患者依据梗阻原因的不同分为三组:原因暂时不明组、肠粘连组及肿瘤广泛转移组,对三组的治疗结果进行统计学分析。结果:肠梗阻原因暂时不明组17例,占总病例的27％,经保守治疗后,15例治愈,2例死亡。粘连性肠梗阻19例(30.2％),经剖腹手术13例,1例死亡,3例出现各种不同并发症;经腹腔镜手术6例。6例完全治愈,无1例并发症发生。肿瘤广泛转移致肠梗阻组27例,单纯化疗5例,治愈3例,死亡2例;剖腹手术或加化疗14例,2例死亡,4例发生各种不同并发症,治愈12例;经腹腔镜手术或加化疗8例,完全治愈,其中1例发生肺炎。在明确梗阻原因病例中,粘连性肠梗阻占41.3％,肿瘤广泛转移致肠梗阻占58.7％。腹腔镜手术或加化疗患者的并发症与剖腹手术或加化疗相比,降低有显著性差异,P<0.05。结论:腹腔内恶性肿瘤术后肠梗阻的最佳治疗方法应在保守治疗同时,明确病因,针对不同病因予以腹腔镜手术或加以化疗。

Tretment of postoperative intestinal obstruction in abdominal malignancy

Objective To study the best treatment of postoperative intestinal obstruction in abdominal malignancy. Methods Between August 1994 and June 2002,63 patients, postoperative intestinal obstruction in abdominal malignant tumor, were studied retrospectively in our hospital. To be divided into three groups: unknow reason ileus, adhesiveness ileus and extensive transference ileus,and anlysis the treatment consequence. Results 2 cases died in 17 unknow reason ileus patients. There were 19 adhesiveness ileus patients, 1 case died and 3 cases took complication in 13 laparotomic patients , none case took complication in 6 laparoscopic patients. There were 27 patients of intestinal obstruction from extensive tranference, 2 cases were died in 5 chemotherapy patients ,2 cases died and 4 cases took complication in 14 laparotomic or add to chemotherapeutic pa-tients,1 case took complication in 8 laparoscopic operative patients. The complications of laparoscopic operation or add to chemotherapy wase significantly lessthan laparotomy or add to chemotherapy (P<0.05). Conclusion laparoscopic operation or add to chemotherapy is the best treatment of postoperative intestinal obstruction in abdominal malignancy.