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合并尿毒症的直肠癌64例治疗分析

Clinical analysis of rectal cancer with uremia:a report of 64 cases
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摘要 目的探讨直肠癌合并尿毒症病人临床特征,提高治疗效果。方法回顾性分析2010年1月至2016年12月福建医科大学附属龙岩第一医院收治的64例直肠癌并发尿毒症病人的临床资料。病人术前行电子肠镜、胸腹部CT、盆腔磁共振、肺功能、心脏彩超等物理学检查及血常规、生化指标、肿瘤标志物、血气分析等实验室检查。所有病人均采用营养风险筛查2002行营养评分,并行运动能力的评估。入院后给予积极的全身支持治疗及血液透析。病人均选择行腹腔镜下直肠癌切除手术,必要时加行预防性末端回肠造口术。结果 64例病人均行腹腔镜下直肠癌切除术,其中根治性手术54例,姑息性手术10例,37例同时行肠造瘘术,术中输尿管损伤2例,骶前大出血1例。术后麻痹性肠梗阻5例,切口感染或全层裂开6例,吻合口瘘5例,肺部感染14例,呼吸衰竭10例,胸腔积液24例,心功能衰竭9例,败血症6例,脑梗死1例,腹腔出血2例。术后5例病人死亡,死因:术后出现吻合口瘘2例,呼吸循环衰竭2例,败血症1例。55例获得随访,20例病人随访期间死亡,其中12例死于肿瘤复发、转移,6例死于尿毒症,1例死于脑梗死,1例死于心肌梗死。结论对于尿毒症合并直肠癌的病人,手术风险极高,但通过充分的术前评估,术前心肺功能锻炼,加强围手术期肠内肠外营养支持,确保手术吻合口的高质量,加强抗感染,充分的血液透析,可减少术后并发症,降低病死率,已不再是手术绝对禁忌证。 Objective To analyze the clinical characteristics of patients with rectal cancer complicated with uremia,and to improve the therapeutic effect.Methods Clinical data of 64 patients with rectal cancer complicated with uremia were reviewed retrospectively.All the patients underwent electronic colonoscopy,thoracic and abdominal CT,pelvic magnetic resonance imaging,pulmonary function,cardiac ultrasonography and other physical examinations.All patients also received blood routine test,biochemical test,tumor marker detection,blood gas analysis,etc.All patients were assessed with nutritional risk screening and exercise ability.After admission,the patients received active systemic support therapy and hemodialysis.All the patients underwent laparoscopic resection of rectal cancer surgery,and preventive ileostomy surgery if necessary.Results Sixteen patients underwent laparoscopic resection of rectal cancer,including radical surgery in 54 cases,and palliative surgery in10 cases.Intestinal fistula surgery was operated on 37 cases simultaneously.Two cases suffered from ureteral injury during operation,and presacral hemorrhage occurred in 1 case.Paralytic intestinal obstruction occurred in 5 cases after operation,wound infection or dehiscence in 6 cases,anastomotic fistula in 5 cases,pulmonary infection in 14 cases,respiratory failure in 10 cases,pleural effusion in 24 cases,heart failure in 9 cases,septicemia in 6 cases,cerebral infarction in 1 case and abdominal hemorrhage in 2 cases.Five patients died after operation because of postoperative anastomotic leakage in 2 cases,respiratory failure in 2 cases and sepsis in 1 case.Fifty-five cases were followed up.There were 20 deaths,including 12 due to tumor recurrence and metastasis,6 cases due to uremia,1 case due to cerebral infarction and 1 case due to myocardial infarction.Conclusions For rectal cancer patients with uremia,surgery has high risk.Through sufficient preoperative assessment,preoperative cardiopulmonary exercise,strengthening the perioperative enteral and parente
作者 李四金 阙长榕 Li Sijin;Que Changrong(Departrnent of Gastrointestinal Surgery,the First Hospital of Longyan,Longyan 364000,China)
出处 《腹部外科》 2018年第5期358-361,共4页 Journal of Abdominal Surgery
关键词 直肠癌 尿毒症 手术治疗 Rectal cancer Uremia Surgical operation
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