左半大肠癌并急性肠梗阻的外科治疗及预后分析

目的：探讨左半大肠癌并发急性肠梗阻的外科治疗方法及效果。方法：回顾性分析2000年10月至2008年2月109例左半结肠癌并发急性肠梗阻行急症手术治疗者的临床资料。结果：109例均行手术治疗, 其中一期根治切除吻合66例。术后并发症发生率为26.6% （ 29/109 ），死亡率为0.9%（1/109）；1, 3, 5年累积生存率分别为94.4%, 73.3%, 43.2%,根治性手术术后1, 3, 5年累积生存率分别为100%，93.6%，66.7%。单因素分析显示，根治性手术、肿瘤Dukes分期、肿瘤病理类型和化疗是影响左半大肠癌并梗阻术后生存率的重要因素。多因素分析显示，根治性手术是影响术后生存率的独立因素。结论：一期根治手术治疗左半大肠癌并肠梗阻可行, 而合理地选择手术方式, 正确的术中操作和围手术期处理对提高疗效, 改善患者生活质量有所裨益。

Surgical treatment and prognosis of left obstructive colorectal carcinoma

ObjectiveTo investigate the effect of surgical management and prognosis of left obstructive colorectal carcinoma.MethodsClinical data of 109 patients with acute left obstructive colorectal carcinoma treated by emergent operation in Xiangya Hospital from October 2000 to February 2008 were retrospectively analyzed.ResultsAll the 109 patients received operation. Of them, 66 patients received one stage tumor resection and intestinal anastomosis. Postoperative complication rate was 26.6%（29/109） and mortality rate was 0.9%（1/109）. The postoperative 1-, 3-, and 5-year survival rates were 94.4%, 73.3%, and 43.2%, respectively. The 1-,3-,and 5-year survival rates of patients receiving curative resection were 100.0%，93.6%, and 66.7%, respectively. With univariate analysis, radical resection, Dukes stage, tumor differentiation, and chemotherapy were found to be significant factors associating with the overall survival. With multivariate analysis, radical resection independently affected the overall survival.ConclusionOne stage radical resection and anastomosis are feasible for left obstructive colorectal carcinoma. Appropriate choice of the operative procedure, skillful operative techniques, and prudential peri-operative treatment can enhance the curative effect and patients’ quality of life.