【摘要】 目的 在于探讨各种类型结肠癌并发急性穿孔的手术治疗原则和方法。文中回顾性分析了结肠癌并发机型穿孔38例,其中肿瘤原发灶穿孔33例,肿瘤近段穿孔 5 例. 其中Duckes分期为: B期10例,C1期15例,C2期15例,D期5例。1期切除吻合术22例,左半结肠切除近段结肠造痿9例,穿孔修补加横结肠造痿7例。最后的手术结果为4例患者分别5和第7天间死于脓毒症、急性肾功能衰竭;7例于术后1年内死于肿瘤复发,16例与术后2年半后出现肿瘤肝转移,至今无瘤生存11例,均为1期切除吻合者。从而本文得出 结论 结肠癌并发急性穿孔急诊手术时间应在控制腹膜炎的基础上力争1期切除肿瘤。

    【关键词】结肠癌 急性穿孔 临床分析

    【中图分类号】R735.3+5 【文献标识码】 C 【文章编号】1005-0515(2010)007-034-03

    Clinical Analysis of 38 Cases of Intercurrent Acute Perforation Caused by Colon Adenocarcinoma

    Wei ShaominHenan ChangGe People’s Hospital 461500

    【Abtract】 The object of this paper is to explore the priciple of diagnosis and treatment of the intercurrent acute perforation caused by colon adenocarcinoma. And a retrospective analysis of 38 cases of intercurrent acute perforation caused by colon adenocarcinoma was performed, including 33 cases of primary tumor Perforation and 5 cases of tumors proximal perforation. Duckes: 10 cases of B, 15 cases of C1, 15 cases of C2, 5 cases of D. Anastomosis after excision was performed in 22 cases in the first stage while left hemicolectomy and colostomy was performed for 9 patients. What’s more, morioplasty of perforation and colostomy of transverse colon was performed in 7 cases. The results were as follows. There were 4 patients who died respectively of sepsis and acute renal failure on the 5th and 7th day after operation. And 7 patients died of recurrent of tumor in 1 year after surgery. And hepatic metastasis of tumors appeared in 16 cases in 2 years and a half. Disease free survival happened in 11 cases which were all those who had received anastomosis after excision. As for the conclusion, this paper proposes that resection of tumours should be performed in the first treatment when emergent operation of acute perforation caused by colon adenocarcinoma is given on the condition that peritonitis must be controlled. ......