摘要
目的探讨粘连松解术联合D3根治术治疗结肠癌合并粘连性肠梗阻患者的疗效。方法回顾性分析2014年7月至2018年2月丹东市第一医院收治的49例结肠癌合并粘连性肠梗阻患者的临床资料,其中男28例,女21例,平均年龄(59.38±9.19)岁,26例行Ⅰ期右半结肠切除术和回肠横结肠端侧吻合术,15例行Ⅰ期左半结肠切除术及回肠横结肠端侧吻合术,8例行左半结肠切除和近端造口远端关闭术。结果所有患者的手术均获成功,无术中并发症,手术时间154~214 min,平均(178.24±25.15)min,术中出血量54~218 mL,平均(88.06±21.79)mL,肿瘤直径28~68 mm,平均(51.92±8.25)mm,清扫淋巴结10~23枚,平均(15.77±3.17)枚。术后Dukes分期:A期8例,B期25例,C期16例。病理分型:低分化腺癌15例,中分化腺癌22例,高分化腺癌12例。术后下床活动时间12~48 h,平均(33.47±4.92)h,术后胃肠功能恢复时间24~72 h,平均(51.94±6.28)h。术后并发切口感染6例,尿路感染3例,肺部感染1例,乳糜漏2例,吻合口漏3例。无死亡病例,均痊愈出院,术后住院时间9~15 d,平均(11.02±1.42)d。术后均予以化疗,随访7~33个月,平均(18.26±4.83)个月,未再次出现肠梗阻,7例发生远处转移,3例复发,5例死亡,无其他病因死亡。结论对于结肠癌合并粘连性肠梗阻患者,严格把握手术的适应证,采取个体化手术方案,掌握手术的关键,是获得手术成功的基础。
Objective To investigate the curative effect of adhesiolysis combined with D3 radical operation on colon cancer with adhesive ileus.Methods The clinical data of 49 patients with colonic cancer and adhesive ileus from July 2014 to February 2018 were analyzed retrospectively,including 28 males and 21 females,with an average age of(59.38±9.19)years,26 patients with stageⅠright hemicolectomy and end to side ileostomy,15 patients with stage phaseⅠleft hemicolectomy and end to side ileostomy were performed.Eight cases underwent left hemicolectomy and distal closure of proximal stoma.Results The operation was successful without complications.The operation time was 154-214 min,the average was(178.24±25.15)min,the average bleeding was 54-218 mL,the average was(88.06±21.79)mL,the tumor diameter was 28-68 mm,the average was(51.92±8.25)mm,the lymph nodes were cleaned up 10-23,the average was(15.77±3.17).Dukes stage:8 cases in A stage,25 cases in B stage and 16 cases in C stage.Pathological classifi cation:15 cases of poorly diff erentiated adenocarcinoma,22 cases of moderately diff erentiated adenocarcinoma and 12 cases of highly diff erentiated adenocarcinoma.The average time of getting out of bed was(33.47±4.92)h,and the recovery of gastrointestinal function was(51.94±6.28)h at 24-72 h.Postoperative complications included incision infection in 6 cases,urinary tract infection in 3 cases,pulmonary infection in 1 case,chylous leakage in 2 cases and anastomotic leakage in 3 cases.There was no death.All patients were cured and discharged.They were hospitalized for 9-15 days,with an average of(11.02±1.42)days.The patients were followed up for 7-33 months,with an average of(18.26±4.83)months.There was no reoccurrence of intestinal obstruction,7 cases of distant metastasis,3 cases of recurrence,5 cases of death,and no other cause of death.Conclusion For colon cancer with adhesive ileus,it is the basis of successful operation to strictly grasp the indications of operation,adopt individualized operation plan and grasp t
作者
李中国
LI Zhongguo(Department of No.1 General Surgery,Dandong No.1 Hospital,Dandong 118000,China)
出处
《中国医药指南》
2020年第32期107-108,共2页
Guide of China Medicine
关键词
结肠癌
粘连性肠梗阻
粘连松解术
D3根治术
化疗
Colon cancer
Adhesive intestinal obstruction
Adhesion lysis
D3 radical surgery
Chemotherapy
