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目的观察结肠癌并发急性肠梗阻一期切除吻合术效果。方法对以“急性肠梗阻”表现入院患者,保守治疗12～48h无效。行钡灌肠检查确诊结肠癌梗阻及梗阻部位,急诊行结肠癌切除,一期肠吻合术,保守治疗期间加强抗炎、纠正水电解质紊乱,术中先于梗阻近端造口减压,用大量温“生理盐水”加“灭滴灵”灌洗肠道,术中仔细缝合,吻合不留张力,术后加强抗炎,维持水电解质平衡,静滴“人血白蛋白”5g使用5～7d,通过腹腔引流管引流情况观察术后吻合口漏发情况。结果12例均无发生吻合口漏,2例因切口感染、切口脂肪液化使切口延迟愈合,其余10例切口甲级愈合。结论正确把握手术时机,加上术前、术中和术后恰当处理,结肠癌并发急性肠梗阻一期切除吻合术,亦有良好效果。可避免不必要的一期先造瘘,二期再切除吻合的麻烦,减少患者痛苦,减少医疗费用。
Objective To observe the effect of primary resection and anastomosis of colon cancer complicated with acute intestinal obstruction. Methods of “acute intestinal obstruction” performance of hospitalized patients, conservative treatment of 12 ~ 48h invalid. Barium enema examination confirmed colon obstruction and obstruction site, emergency colon cancer resection, an intestine anastomosis, conservative treatment to strengthen the anti-inflammatory, correct water and electrolyte disorders, intraoperative prior to obstruction proximal stomal decompression, with a large number of Warm “saline” plus “metronidazole” lavage the intestine, surgery carefully sutured, anastomosis without leaving tension, postoperative anti-inflammatory to maintain water and electrolyte balance, intravenous infusion of “human serum albumin” 5g using 5 ~ 7d , Through the peritoneal drainage tube drainage observed anastomotic leakage. Results No anastomotic leakage was found in 12 cases, 2 cases were infected by incision, incision fat liquefaction delayed healing of incision, the other 10 cases of incision healed. Conclusion Correct grasp of the timing of surgery, coupled with preoperative, intraoperative and postoperative appropriate treatment, colon cancer complicated with acute intestinal obstruction by an anastomosis, also has good results. To avoid unnecessary first stage fistula, two resection anastomosis trouble, reduce patient pain, reduce medical costs.