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报告手术治疗直肠结肠癌86例。男52例,女34例,男女之比1.5:1。年龄最小19岁。最大72岁。20~40岁30例,占34.7%。自出现症状到确诊时间在3个月内42例(48.8%),4~6个月28例(32.6%),6个月以上16例(18.6%)。直肠癌39例,占45.4%,升结肠癌26例,占30.2%。并发急、慢性肠梗阻及癌性穿孔57例,占66.3%,行根治术64例,占74.4%。随访52例,时间1~3年,健在40例,复发7例,死亡5例。讨论:①早期诊断。本组误诊痢疾、结肠炎最多,在39例直肠癌中,入院前延误诊断13例,误诊时间最长2年。造成误诊原因:①对本病认识不足;②没有做直肠指诊,因此,提高对早期症状认识,定期肛诊,大便潜血检查,钡灌肠,结肠镜检,可提高对本病的早期诊断;③发病年龄问题,本组86例,30~40岁30例,占34.7%,其中25岁内9例,占10.5%。发病年龄趋于年青,而且病情发展快,死亡率高应引起重视。④治疗问题,外科手术是治疗直肠结肠癌的主要手段。能切除的行根治术,即使不能切除也争取行姑息性切除,这样可缓解症状,延长生存时间。对并发急性肠梗阻者,我们的治疗原则:病变位于升、横、降结肠所致的梗阻,力争I期切除吻合术;对低位乙状结肠、直肠病变所致的梗阻则根据病人情况及术者吻合技巧选择I期或Ⅱ期手术。对I期手术切除,必须做到“上要空,中要松,下要通”原则。此类
Surgical treatment of rectal colon cancer was reported in 86 cases. There were 52 males and 34 females. The male to female ratio was 1.5:1. The youngest is 19 years old. The maximum is 72 years old. 20 to 40 years old 30 cases, accounting for 34.7%. From the onset of symptoms to diagnosis within 42 months (48.8%), 4 to 6 months (28.6%), 16 months (16.6%). 39 cases of rectal cancer, accounting for 45.4%, or 26 cases of colon cancer, accounting for 30.2%. Concurrent acute and chronic intestinal obstruction and cancerous perforation in 57 cases, accounting for 66.3%, radical resection 64 cases, accounting for 74.4%. Fifty-two patients were followed up for a period of 1 to 3 years. 40 patients survived, 7 relapsed, and 5 died. Discussion: 1 Early diagnosis. The group was misdiagnosed as dysentery and colitis. In 39 cases of rectal cancer, 13 cases were diagnosed with delay before admission, and the misdiagnosis time was as long as 2 years. Misdiagnosis reasons: 1 lack of knowledge of the disease; 2 did not do digital rectal examination, therefore, to improve awareness of early symptoms, regular rectal examination, fecal occult blood examination, barium enema, colonoscopy, can improve the early diagnosis of this disease; 3 Age of onset, this group of 86 cases, 30 to 40 years old 30 cases, accounting for 34.7%, of which 9 cases were 25 years old, accounting for 10.5%. The age of onset tends to be young, and the condition develops rapidly. The high mortality rate should be paid attention to. 4 Treatment problems, surgery is the main means of treatment of colorectal cancer. Radical resection can be performed, even if it cannot be removed, palliative resection is performed, which can relieve symptoms and prolong survival time. For patients with acute intestinal obstruction, our principle of treatment: the lesion is located in the obstruction caused by ascending, transverse, and descending colon, and strives for a resection and anastomosis; the obstruction caused by the low sigmoid colon and rectal disease is based on the patient’s condition and the patient’s anastomosis. Tips to choose I or II surgery. For the phase I surgical resection, the principle of “top to top, middle to loose, and bottom to pass” must be achieved. This class