例1,男性,71岁,因“间歇性脐周围痛、伴黑便1个月,腹痛加重3d”于1997年12月9口入院。摄x线腹部平片提示:消化道穿孔。在硬膜外麻醉下行剖腹探查术。探查发现:腹腔内有气体溢出,腹腔内有约1500ml脓性液体,结肠明显扩张,直径约10cm,色泽正常。直肠腹膜返折部可触及一约2cm×6cm肿瘤,距其15cm部乙状结肠前壁有一直径3cm穿孔,局部有块状粪便滞留,乙状结肠内有大量软质粪便积存。阻断穿孔部近端肠管,清除局部粪便,将远端粪便自肛门排出,置入引流管,用外用盐水1000ml和2%甲硝唑溶液500ml冲洗远端肠腔。自肠腔内探查肿瘤,其向腔内突出,呈菜花状,局部坏死、破溃,切取2cm×1cm肿瘤组织送病理检查,局部未触及肿大淋巴结。病理诊断:直肠腺癌。痊愈出院后近期随访疗效良好。例2,男性,52岁。于1997年12月17日因“上腹部剧痛7h”入院。摄X线腹部平片提示:消化道穿孔。在硬膜外麻醉下剖腹探查。术中见:腹腔内有气体溢出,内有约1000ml脓性渗液,味臭,结肠明显扩张,内充满软质粪便,尤以乙状结肠明显,直径约10cm。距直肠30cm乙状结肠前壁有一6cm×4cm肿物,已侵犯浆膜,距其近端15cm有一约5cm×5cm肠壁局部呈褐色、壁薄,中央部有两处直径各约0.5cm穿孔,有少量粪便外溢。切取肿瘤组织做冰冻病理检查,结果为结肠高分化腺癌。术 Example 1, male, 71 years old, admitted to hospital on December 9, 1997 due to “intermittent umbilical pain, accompanied by melena for one month, and abdominal pain increased by 3 days.” Photographs taken on the abdomen of the x-ray film: perforation of the digestive tract. A laparotomy is performed under epidural anesthesia. Exploration revealed that there was gas leakage in the abdominal cavity, about 1500 ml of purulent fluid in the abdominal cavity, and the colon was significantly dilated. The diameter was about 10 cm and the color was normal. Approximately 2cm x 6cm tumors can be touched in the rectal peritoneal plication, and a 3cm diameter perforation is found in the anterior sigmoid wall of the 15cm septum. Partial fecal retention occurs in the sigmoid colon, and a large amount of soft feces accumulates in the sigmoid colon. The proximal intestine of the perforated part was blocked, the local feces were removed, the distal feces was discharged from the anus, the drainage tube was placed, and the distal intestine was washed with 1000 ml of external saline solution and 500 ml of 2% metronidazole solution. The tumor was explored from the intestine, and it protruded into the cavity. The lesion was cauliflower-like, with local necrosis and ulceration. The 2cm x 1cm tumor tissue was harvested for pathological examination, and local lymph nodes were not touched. Pathological diagnosis: rectal adenocarcinoma. The curative effect was good after follow-up after recovery. Case 2, male, 52 years old. He was admitted to hospital on December 17, 1997 for “7h epigastric pain.” X-ray abdomen plain film tips: perforation of the digestive tract. Laparotomy under epidural anesthesia. See intraoperatively: there is gas leakage in the abdominal cavity, with about 1000 ml of purulent exudate, smelly smell, obvious expansion of the colon, and full of soft stools, especially in the sigmoid colon, with a diameter of about 10cm. 30cm from the rectum 30cm sigmoid colon anterior wall has a 6cm × 4cm tumor, has invaded the serosa, from its proximal 15cm has about 5cm × 5cm local intestinal wall was brown, thin wall, the central part of the two diameter of about 0.5cm perforation, there A small amount of feces spilled. Excision of tumor tissue for frozen pathology results in a well differentiated adenocarcinoma of the colon. Surgery