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目的探讨结肠癌致急性肠梗阻的围手术期处理和手术方式的选择,为临床治疗提供参考依据。方法回顾性分析55例结肠癌并发肠梗阻手术治疗的临床资料:乙状结肠24例,降结肠13例,右半结肠14,横结肠4例;急诊手术28例和择期手术27例。结果急诊组:根治性切除18例,姑息性切除5例,回肠暂时或永久性造口术共4例,回结肠短路术1例;择期组27例:根治性切除26例,姑息性切除6例,横结肠造口手术1例,回肠永久性造口术1例。急诊手术组发生吻合口瘘3例,腹腔感染5例、肺部感染3例,死亡1例。择期手术组发生吻合口瘘1例,肺部感染2例;炎性肠梗阻1例。急诊手术组围手术期死亡率为(7.1%)。结论对老年结肠癌并发急性肠梗阻的处理需根据患者的具体情况决定手术方式,选择正确的手术时机和手术方式能获得良好的治疗效果,同时重视围手术期处理。
Objective To investigate the perioperative management and surgical methods of acute intestinal obstruction caused by colon cancer, and provide reference for clinical treatment. Methods The clinical data of 55 cases of colon cancer complicated with intestinal obstruction were retrospectively analyzed: 24 cases of sigmoid colon, 13 cases of descending colon, 14 cases of right colon, 4 cases of transverse colon; 28 cases of emergency operation and 27 cases of elective surgery. Results Emergency group: Radical resection in 18 cases, palliative resection in 5 cases, ileal temporary or permanent ostomy in 4 cases, ileocolic short-circuit in 1 case; elective group in 27 cases: radical resection in 26 cases, palliative resection 6 In one case, there was 1 case of transverse colostomy and 1 case of ileal permanent ostomy. There were 3 cases of anastomotic leakage in the emergency surgery group, 5 cases of abdominal infection, 3 cases of pulmonary infection, and 1 case of death. In the elective surgery group, there was one case of anastomotic leakage, two cases of pulmonary infection, and one case of inflammatory bowel obstruction. Perioperative mortality in the emergency surgery group was (7.1%). Conclusion The treatment of acute colonic obstruction in elderly patients with colonic cancer must be based on the specific circumstances of the patients. The correct surgical timing and surgical methods can be used to obtain good therapeutic effects. At the same time, it pays attention to perioperative management.