结肠癌急性梗阻的治疗体会

目的：总结结肠癌急性梗阻的治疗经验。方法：回顾性分析了我院10年中急诊手术的结肠癌梗阻47例。结果：右半结肠癌22例，其中一期切除吻合15例，分期手术3例，捷径手术2例，肠造口2例。左半结肠癌24例，其中一期切除吻合4例，Hartmanns手术8例，结肠次全切除2例，一期造口、二期肿瘤切除5例，单纯造口术5例，另1例同时性结肠多原发癌行结肠次全切除。切口感染率为10．6％，其中一期切除吻合为15．8％；一期切除吻合吻合口漏2例（10．5％）；围手术期死亡2例（4．3％）。结论：结肠癌急性梗阻，应在积极术前准备的同时，尽早手术。右半结肠癌梗阻应在充分肠减压的基础上行I期切除吻合，左半结肠癌梗阻应首选Hartmanns手术。

Treatment experiences for colonic cancer with acute obstruction

Objective:To discuss the management of colonic cancer with acute obstruction.Methods:47 patients with acute obstruction of colonic cancer were analysed retrospectively.Results:For 22 patients with right colonic cancer obstruction, 15 cases were treated with primary resection and anastomosis; 3 cases were treated with colectomy and second-stage anastomosis. The other operative methods included ileocolostomy (2 cases), cecostomy (1 case) and ileostomy (1 case). For 24 patients with left colonic cancer obstructon, 4 cases were treated with primary resection and anastomosis; 8 cases were treated with Hartmanns procedure. The other management included subtotal colectomy (2 cases); colostomy with second-stage resection (5 cases) and colostomy (5 cases). One patient with simultaneously multifocal colonic cancer was also treated with subtotal colectomy. The overall infection rate was 10.6% (5/47) and the mortality rate was 4.3% (2/47). For 19 cases of primary resection and anastomosis, the wound infection rate was 15.8% (3 cases) and anastomotic leakage occurred in 2 cases (10.5%).Conclusion:One-stage curative operation is safe and suitable for most of the patients with obstructing carcinoma of the right colon and Hartmanns procedure is preferred surgical treatment for the patients with obstructing carcinoma of the left colon.