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目的探讨中低位直肠癌合并自发性穿孔的诊断与治疗措施。方法回顾性分析11例中低位直肠癌合并肠穿孔的诊断与治疗。收集患者的一般情况、发病时临床表现、实验室检查、术中探查情况、手术方式、病理资料及患者结果等临床资料,探讨其临床诊疗特点。结果除弥漫性腹膜炎及腹腔内游离气体等消化道穿孔常见临床表现外,穿孔12 h内,11例中有7例(63%)白细胞计数未见升高,其中有4例(36%)白细胞计数下降明显。术前仅2例(18%)经直肠指诊诊断为直肠癌。除3例(28%)肿瘤自身穿孔外,8例(72%)穿孔部位位于乙状结肠。9例(81%)一期肿瘤切除患者中8例痊愈出院。结论术前明确诊断较为困难,直肠指诊是术前明确诊断的唯一方法。弥漫性腹膜炎症状后短期内出现白细胞水平下降这种现象可能是下消化道穿孔特征性表现。除少数肿瘤部位穿孔外,穿孔部位多位于乙状结肠。治疗以手术治疗为主,一期肿瘤切除是安全可靠的。
Objective To investigate the diagnosis and treatment of middle and low rectal cancer with spontaneous perforation. Methods Retrospective analysis of 11 cases of low and middle rectal cancer with intestinal perforation diagnosis and treatment. To collect the general situation of patients, the clinical manifestations at onset, laboratory tests, intraoperative exploration, surgical methods, pathological data and patient results and other clinical data to explore the clinical diagnosis and treatment characteristics. Results In addition to diffuse peritonitis and intraperitoneal free gas and other gastrointestinal perforation common clinical manifestations, perforation within 12 h, 11 cases of 11 cases (63%) did not increase the white blood cell count, of which 4 cases (36%) of white blood cells Count down significantly. Only 2 patients (18%) were diagnosed with rectal cancer by digital rectal examination. Except perforation in 3 cases (28%), 8 cases (72%) were located in the sigmoid colon. Eight of nine patients (81%) with tumor resection were cured and discharged. Conclusions The definite diagnosis before surgery is more difficult. The digital rectal examination is the only way to confirm the diagnosis before operation. Diffuse peritonitis symptoms appear shortly after the white blood cell level decreased This phenomenon may be characterized by lower gastrointestinal perforation. In addition to a small number of tumor perforation, the perforation site located in the sigmoid colon. Surgical treatment-based treatment, a tumor resection is safe and reliable.