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结肠癌并发结肠穿孔的发生率约为5%,1.7%穿孔并伴有结肠梗阻,穿孔的部位多见于结肠相对固定部位,即升结肠、降结肠、横结肠肝曲。结肠内压增高不能通过回盲瓣得到缓解而致盲肠壁高压下缺血坏死、穿孔。结肠癌并发梗阻穿孔为急腹症需急诊手术,手术依穿孔至手术时间、穿孔部位、穿孔病人的全身情况而选择不同的术式。手术时要注意清除腹腔污染,充分腹部引流,同时还要考虑到结肠癌病人属晚期病人,但亦应采取积极的手术治疗。随着手术方式的不断改进,术中采取肠灌洗,部分梗阻穿孔的病人仍可取Ⅰ期根治术。
The incidence of colorectal cancer complicated with perforation of the colon is about 5%, 1.7% perforation with colonic obstruction, and the perforation site is more common in the relatively fixed parts of the colon, ie, ascending colon, descending colon, and transverse colonic liver curvature. Increased intracolonic pressure can not be alleviated by the ileocecal valve, resulting in cecal wall ischemia under high pressure, perforation. Acute obstruction of colorectal cancer complicated by obstructive acute abdominal surgery requires emergency surgery, surgery according to perforation to surgery time, perforation, perforation of the patient’s general condition and choose different surgical procedures. During the operation, attention should be paid to the removal of abdominal contamination and full abdominal drainage. It is also necessary to consider that colon cancer patients are advanced patients, but active surgical treatment should also be taken. With the continuous improvement of surgical methods, intraoperative ileal lavage, partial obstruction and perforation of patients can still take a radical mastectomy.