大肠癌合并梗阻的特点为:①病人多为老年患者,常合并有全身其它重要脏器功能不全;②病程较长。由于结肠梗阻症状常不典型,故就诊晚、误诊率高,使手术的耐受性下降;③病期晚。相当部分的病人为晚期癌,已转移固定,给根治术的施行造成困难;④为闭袢性梗阻,易穿孔形成粪便性腹膜炎;⑤大肠有大量粪便和细菌,容易发生术后各种并发症;⑥大肠梗阻有时需多次手术,对病人机体损伤较大。因而作为临床医师应对该疾病有高度警惕,以尽早诊断,争取治疗时机。其手术方式的选择,目前仍是有争议的问题。多数学者主张:右半结肠肿瘤可行一期切除吻合,而左半结肠应按传统作分期手术。但近年来一期切除吻合的成功率有了大幅度的上升,其并发症的发生与死亡机会不比分期手术多,因此我们认为:手术方法的选择应根据梗阻近端肠段的病理变化轻重和全身情况来决定,应尽可能争取一期切除吻合。其优点在于①能及时切除肿瘤;②减少因造口给病人带来的不便;③避免多次手术的痛苦;④缩短住院时间、降低费用。本组一期切除病例均获满意效果。关于一期手术吻合口瘘的预防:长期以来那种认为肠内粪便是致吻合口瘘的重要原因的说法,经过近年来的深入研究认识到肠内容物对结肠粘膜上皮具有重要的营养作用,肠腔内的正常菌群为结肠粘膜上皮提供营养 Colorectal cancer with obstruction is characterized by: 1 patients are mostly elderly patients, often associated with systemic other important organ dysfunction; 2 longer course. Because the symptoms of colonic obstruction are often not typical, the late diagnosis and high rate of misdiagnosis result in a decrease in the tolerability of the operation. A significant proportion of patients are advanced cancers, which have been metastasized and fixed, causing difficulties in the implementation of radical surgery. 4 Closed fistulas are obstructive and easily perforate to form fecal peritonitis; 5 There is a large amount of feces and bacteria in the large intestine, prone to postoperative complications. ;6 Colonic obstruction sometimes requires multiple operations, the body damage of the patient. Therefore, as a clinician to deal with the disease has a high degree of vigilance to diagnose as soon as possible and fight for the timing of treatment. The choice of surgical methods is still a controversial issue. Most scholars advocate that the right hemicolectasis can be performed with one-stage resection and anastomosis, while the left colon should be performed conventionally by stages. However, in recent years, the success rate of resection and anastomosis has increased dramatically. The incidence of complications and deaths are not much more than scores. Therefore, we believe that the choice of surgical methods should be based on the pathological changes of the proximal bowel obstruction and Determined by the general condition, we should strive for a one-stage resection and anastomosis. The advantage is that 1 can promptly remove the tumor; 2 reduce the inconvenience caused by stoma to the patient; 3 avoid the pain of multiple operations; 4 shorten the length of stay and reduce costs. One-stage resection in this group was satisfactory. With regard to the prevention of anastomotic leakage at the first stage of operation, it has long been known that the intestinal faeces are an important cause of anastomotic leakage, and after extensive studies in recent years, it has been recognized that intestinal contents have important nutritional effects on colonic mucosa epithelium. Intestinal normal flora provides nutrition for colonic mucosal epithelium