目的:探讨老年结直肠癌并急性肠梗阻的处理原则和方法。方法:回顾性分析10年间收治的78例(70～80岁)结直肠癌并急性肠梗阻的临床资料。78例中Dukes B期20例,C期18例,D期40例。全部患者经手术治疗,包括急诊手术46例,择期性手术32例。采用右半结肠一期切除肠吻合治疗30例,左半结肠一期切除吻合40例。Hartmann 5例, Di×on手术2例,肿瘤近端肠管造瘘1例。结果:术后出现并发症16例(20.5%)21例次,包括切口感染14例次,腹腔感染5例次和吻合口瘘2例次,死亡3例(3.85%),75例(96.2%)痊愈出院。结论:对于急性结直肠癌性梗阻除非有急诊手术指征,应首先采用非手术治1～2 d,尽可能转为择期手术;一期切除吻合治疗结直肠癌并发急性梗阻,是方便可行而安全有效的方法,加强围手术期处理是手术成功的关键。
目的 总结术后早期炎性肠梗阻的临床特点及诊治经验。方法 回顾性分析我院2004年1月至2010年12月期间收治的22例腹部手术后早期炎性肠梗阻患者的临床资料。结果 全组均行保守治疗，均治愈出院。肠梗阻解除时间平均6.5d。2例出院后再次出现慢性肠梗阻，经保守治疗好转。结论 术后早期炎性肠梗阻在腹腔严重感染性疾病术后多见，治疗以保守治疗为主，同时应动态观察腹部症状、体征变化，严防误诊、误治。
Objective To explore the clinical effects of ileus tube in treatment of colonic obstruction caused by colorectal carcinoma. Methods Thirtytwo colorectal carcinoma patients with colonic obstruction admitted to our hospital from December 2005 to December 2008 were given onestage radical excision and anastomosis after transnasal or transanal placement of ileus tube for colonic decompression and drainage. Results Combined placement of transnasal and transanal ileus tube was successfully carried out in 19 cases, while the other 13 cases were treated only with transnasal ileus tube. Abdominal pain and distention of all cases were relieved 12-36 h after tube placement, while those of 26 cases disappeared 48-96 h later. Compared with before tube placement, abdominal circumferences of all cases were significantly reduced after tube placement, the mean reduction rate was (81.3±19.6)% vs. 100% (t=3.586, P=0.02). All cases were successfully treated by onestage radical excision and anastomosis 5-7 d after placement, and no serious complications such as peritoneal infection, anastomotic leakage etc. were found. Conclusion Preoperative intubation of ileus tube can enhance the therapeutic effects of onestage radical excision and anastomosis in patients with colorectal carcinoma combined with colonic obstruction.
摘要:目的:探讨老年人梗阻性大肠癌的围手术期处理。方法:回顾性分析2003年至2008年间71例60岁以上老年人梗阻性大肠癌的围手术期处理情况。 结果:术前发现并存病者43例,术中出现并发症19例,术后发生并发症37例得,除5例死亡外,均得到有效控制,死亡原因与并存疾病有关。结论:加强围手术期处理,积极治疗并存疾病,老年人梗阻性大肠癌的治疗同样能取得满意的效果。Abstract: Objective:To study the perioperative measures for the aged patients with Obstructive Colorectal Cancer. Methods: Seventyone cases above 60 years with Obstructive Colorectal Cancer were analysed retrospectively on their individual accompanied diseases and perioperative treatments, from 2003 to 2008.Results: Fortythree cases of them had suffered from other diseases. Midoperative complications occurred in 19 cases. Postoperative complications occurred in 37 cases. Except 5 cases of death, complications occurring in others cases were well controlled. The death causes mainly were correlated with accompanied chronic diseases. Conclusion: Strengthen care, active management of other chronic diseases are important significantly for senile patients with colorectal carcinoma to get satisfied outcome.
目的探讨术后早期肠梗阻的临床特点、诊断及治疗。方法对10例术后早期肠梗阻患者进行回顾性分析。结果10例均为机械性肠梗阻。保守治疗6例，其中治愈5例，死亡1例； 手术治疗4例，其中3例术中有绞窄性肠梗阻征象，均治愈。1例术中发现为广泛癌性粘连，行部分粘连松解术，术后第8天再发肠梗阻，保守治疗1天无效，患者自动出院。结论术后早期肠梗阻诊断并不困难； 保守治疗多数有效，故宜先行保守治疗； 可疑肠绞窄时应及时中转手术。
目的:探讨大肠癌致肠梗阻的诊断和手术方法。方法:回顾分析2002～2008年间65例结直肠癌致肠梗阻病例的外科治疗资料。结果:术后出现并发症9例,切口感染6例,腹腔感染2例,吻合口瘘1例。结论:结直肠癌致肠梗阻应争取Ⅰ期切除吻合。合理选择手术方式,做好术中结肠灌洗和围手术期治疗是手术成功关键。
目的 探讨胆石性肠梗阻的诊断与治疗方案。方法 对我科1990~1999年诊治的11例胆石性肠梗阻的临床表现、治疗结果、术前诊断及手术时机与术式选择进行回顾性分析。结果 11例患者均痊愈出院。其中1例患者发生急性肾功衰竭，2例患者切口感染。3例未做十二指肠瘘口处理的患者有2例在半年后行胆囊切除十二指肠瘘口修补治愈。结论 根据患者全身情况选择不同的手术方式均可取得满意的效果。
Objective To evaluate initial experience with shape memory alloy stent as an alterative to colostomy in patients with intestinal obstruction of rectal cancer. Methods Twenty-one patients with acute and chronic rectal obstructions from malignant causes underwent stent placement. After rectal stent was slenderized in ice water, it was inserted into the strictured rectum by hand or sigmoidoscope. Nitinol mesh stent were deployed in hot water. Results Eighteen patients who had underwent rectal stent placement achieved clinical decompression within 5 hours. Colostomy underwent in 3 patients due to stent failure. Eighteen patients with stent were followed-up, 14 cases died in 56-720 days and 4 other cases were still alive without intestinal obstruction in 2-15 months. Conclusion Nitinol mesh stent may be useful in the management of terminal or high-risk surgical patients for palliative purposes shuning colostomy. Palliation of stent combined with chemotherapy and immunotherapy can be performed to improve survival.
ObjectiveTo analyze the risk factors affecting the postoperative ileus after total gastrectomy in elderly patients with gastric cancer. MethodsThe elderly patients with gastric cancer after total gastrectomy admitted to the Second Department of General Surgery of Shaanxi Provincial People’s Hospital from January 2015 to December 2020 were retrospectively collected and the postoperative ileus was analyzed. Meanwhile the risk factors affecting the postoperative ileus after total gastrectomy in the elderly patients with gastric cancer were analyzed using univariate and multivariate logtistic regression analyses. ResultsA total of 306 elderly patients with gastric cancer who met the inclusion and exclusion criteria of this study were collected, 33 (10.8%) of whom suffered the postoperative ileus after surgery. The results of multivariate logtistic regression analysis showed that the preoperative anemia [OR (95%CI)=2.740 (1.181, 6.356), P=0.019], preoperative complicated intestinal obstruction [OR (95%CI)=3.286 (1.208, 8.935), P=0.020], open operation [OR (95%CI)=3.753 (1.298, 10.848), P=0.015], and operative time ≥400 min [OR (95%CI)=3.902 (1.705, 8.925), P=0.001] increased the risk probability of postoperative ileus after total gastrectomy in the elderly patients with gastric cancer. ConclusionsAccording to the analysis results of this study, the preoperative anemia and complicated intestinal obstruction, as well as the adopted open surgery and operation time ≥400 min are the risk factors of postoperative ileus in elderly patients with gastric cancer after total gastrectomy. When total gastrectomy is chosen for elderly patients with gastric cancer, preoperative physical status needs to be adjusted, such as correcting anemia and removing preoperative intestinal obstruction. During operation, the operation modus should be prior to the minimally invasive surgery according to the individual conditions of elderly patients and the operation skills of surgeons should be improved so as to reduce postoperative ileus.