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目的探讨结直肠癌并急性肠梗阻的外科治疗原则和方法。方法回顾性分析我院1995年1月~2005年1月收治的129例合并急性肠梗阻的结直肠癌病例。在42例右半结肠癌患者中,一期行切除吻合术37例,5例因广泛转移而仅行造瘘术;在87例左半结肠癌和直肠癌患者中,68例一期行Hartmann术、二期行闭瘘吻合术,6例行一期切除吻合术,2例行乙状结肠切除吻合加横结肠造口术,3例行肿瘤切除永久性横结肠或乙状结肠造口术,8例行姑息性单纯结肠造口术。结果术中出现并发症29例(22.5%),其中切口感染11例,切口裂开3例,肺部、腹腔、泌尿系感染各1例,心、肺、肾功能不全9例,感染性休克1例,循环功能不全1例、肺栓塞1例,后3例死亡(2.3%),其余痊愈出院,无一例发生吻合口瘘。结论结直肠癌合并急性肠梗阻多属中晚期,手术是解除梗阻的有效方法,术式选择应根据病变部位和病情而定,做好围手术期处理是减少并发症、降低病死率的关键。
Objective To investigate the surgical treatment of colorectal cancer and acute intestinal obstruction principles and methods. Methods A retrospective analysis of our hospital from January 1995 to January 2005 admitted 129 cases of acute intestinal obstruction in patients with colorectal cancer. Among the 42 patients with right colon cancer, 37 patients underwent resection and anastomosis in one and only 5 patients underwent extensive ostomy. In 87 patients with left colon cancer and rectal cancer, 68 patients underwent Hartmann Two cases of closed fistula anastomosis, 6 cases of a resection and anastomosis, 2 cases of sigmoid colon resection and anastomosis plus transverse colostomy, 3 cases of tumor resection of permanent transverse colon or sigmoid colostomy, 8 cases of palliative Simple colostomy. Results Complications occurred in 29 cases (22.5%) during the operation. There were 11 incisional wounds, 3 incision incisions, 1 pulmonary, abdominal cavity and urinary tract infection, 9 heart, lung and renal insufficiency, septic shock 1 case, 1 case of circulatory insufficiency, 1 case of pulmonary embolism, 3 cases after death (2.3%), the rest were cured and discharged, no case of anastomotic fistula occurred. Conclusion Colorectal cancer with acute intestinal obstruction is mostly in the advanced stage. Surgery is an effective way to relieve the obstruction. The choice of surgical procedure should be based on the location of the lesion and the condition. Perioperative management is the key to reduce complications and reduce mortality.