结肠癌并发穿孔18例治疗体会

目的:探讨结肠癌并发穿孔的临床特点、早期诊断和提高治疗效果的措施. 方法:回顾性分析自1998年以来我院收治的18例急诊手术治疗的结肠癌并发穿孔患者的临床资料.结果:18例患者中,16例术后恢复良好,并经综合治疗后痊愈出院;2例死亡,其中1例死于感染性休克,1例死于肿瘤晚期.结论:结肠癌并发穿孔的早期诊断是治疗本病的关键,手术行Ⅰ期切除肿瘤病灶是最佳的治疗选择.     

高龄低肺功能食管、贲门癌患者的外科治疗

目的探讨高龄低肺功能食管、贲门癌患者的外科手术治疗、手术方式的选择及围手术期的合理处理。方法回顾性分析1990年1月~2003年12月44例70岁以上低肺功能食管、贲门癌患者的手术切除方式、围手术期处理及术后呼吸机的应用。结果术后19例行呼吸机辅助呼吸,围手术期死亡3例,其中2例死于呼吸衰竭,1例吻合口瘘患者死于胸腔感染,全身衰竭。结论由于手术技术的改进、术后呼吸机的应用及围手术期的正确处理,高龄低肺功能食管、贲门癌患者的手术适应证可相对扩大。     

胃癌并发穿孔患者的外科手术治疗临床分析

目的对胃癌并发穿孔的临床诊断和外科手术治疗的效果进行分析评价。方法对26例胃癌合并穿孔患者的临床资料、病理特点和手术方式进行回顾性分析。结果 26例患者中12例行穿孔修补术(其中5例患者在行穿孔修补术后20 d左右,行二期手术姑息性切除或根治性切除),11例行姑息性切除术,3例行根治性切除术。围手术期死亡3例,死亡原因为感染性休克致多脏器功能衰竭和穿孔修补处再穿孔。结论胃癌并发穿孔患者多数病情危重且复杂,早期诊断和积极的手术治疗,选择正确合理的手术方式对降低胃癌穿孔患者病死率、改善其预后有重要意义。     

老年性结直肠癌并急性肠梗阻38例诊治体会

目的探讨老年结直肠癌并急性肠梗阻的诊治。方法回顾性分析38例老年结直肠癌并发急性肠梗阻患者的住院资料。结果 29例行结肠癌根治切除一期吻合,3例行根治切除一期吻合近段结肠造口,1例行Hartmann术,3例行姑息切除一期吻合,1例行短路术,2例行单纯造口术。发生2例吻合口漏经保守治疗痊愈,切口感染3例,2例死于多器官功能衰竭。结论老年人结直肠癌并急性肠梗阻,只要加强围手术期处理,根据全身情况及局部条件,合理选择术式,争取行一期手术,可以获得满意的临床效果。     

结直肠癌并急性肠梗阻56例临床经验

目的探讨结直肠癌并发急性肠梗阻的外科治疗方法及效果。方法回顾性分析2003～2008年我院56例结直肠癌并发急性肠梗阻行急症手术治疗患者的临床资料。右半结肠癌及横结肠癌12例,左半结肠癌28例行Ⅰ期结肠切除吻合术,14例行Hartmann术,2例低位直肠癌行Miles术。结果全组病例术后恢复良好,无吻合口漏发生,无围手术期死亡,切口感染3例（5.4%）。结论合理选择术式,做好围手术期处理,结直肠癌并急性肠梗阻行Ⅰ期切除吻合术是安全可行的。     

结肠癌伴肠梗阻36例治疗体会

目的探讨结肠癌伴肠梗阻的手术治疗原则、方法及临床效果。方法回顾性分析本院2009年1月至2011年1月间收治的36例结肠癌伴肠梗阻患者的临床资料。结果 36例均行外科手术治疗,其中24例行结肠Ⅰ期切除吻合术,包括右半结肠癌并发梗阻14例,左半结肠癌和直肠癌并梗阻10例,8例采用分期手术,4例行Ⅰ期造瘘、Ⅱ期肿瘤切除吻合术。术后并发吻合口瘘2例,肺部感染2例,切口感染4例,手术并发症发生率22%。1例围手术期死亡。术后0.5、1、3年的随访生存率分别为:79%、65%、49%。结论手术治疗结肠癌继发急性肠梗阻临床疗效明显,Ⅰ期切除吻合手术治疗结肠癌并梗阻是可行的,预后良好,值得临床推广。选择合适的外科处理方法是提高疗效、减少并发症的关键。     

合并慢性阻塞性肺病患者上腹部手术的围手术期处理体会

目的探讨上腹部手术合并慢性阻塞性肺病患者围手术期处理方法。方法回顾性分析我院近5年33例慢性阻塞性肺病患者行上腹部手术围手术期术前、术中、术后处理的临床资料。结果中重度慢性肺病患者术后并发呼吸道感染8例,心功能不全5例,胸腔积液4例,3例行胸腔穿刺;并发Ⅰ型呼吸衰竭2例,Ⅱ型呼吸衰竭6例。治愈30例。死亡3例。死亡原因:合并霉菌性败血症2例,合并心功能衰竭1例。结论术前充分准备、术后正确处理可降低慢性阻塞性肺病患者上腹部手术术后呼吸衰竭发生率,急诊手术需谨慎。     

老年外科急腹症围手术期风险与对策

目的探讨老年外科急腹症围手术期的风险与临床处理对策。方法回顾分析07年1月到09年9月本院普外科手术治疗的54例老年外科急腹症病人围手术期的风险因子和处理措施。结果 52例痊愈,2例死亡,其中1例,男,72岁,乙状结肠癌梗阻,死于严重营养不良,低蛋白血症,心力衰竭;另1例,男,84岁,胆囊炎、胆结石,死于慢性支气管炎肺气肿,呼吸衰竭。术后切口液化3例,切口感染2例,并发胸腔积液3例,肺部感染2例,高血糖6例,心动过速4例,高血压3例。结论老年急腹症病人,通过手术前严密病情分析,综合分析评估,术前干预治疗,周密的把握手术方式,可降低手术风险到最低程度。     

老年结肠癌并发急性穿孔3例临床分析

结肠癌并发急性穿孔以老年人多见，由于高龄体弱，合并症多，多器官功能不全，因此病死率高。本科收治老年结肠癌并发急性穿孔3例，围手术期死亡2例，现分析如下。     

经皮肾镜碎石术并发脓毒血症的风险与防治

经皮肾镜碎石术（percutaneous nephrolithotomy．PCNL）围术期可出现多种相关并发症．脓毒血症是其中最严重之一．一旦发生感染性休克常致多器官功能衰竭，围术期死亡率高。本文以PCNL中并发严重脓毒血症及感染性休克致多器官功能衰竭为例，旨在分析该类手术并发脓毒血症的风险因素．探讨其防治措施。     

Surgical treatment of complicated sigmoid diverticulitis: our experience

Traditionally, surgical sigmoid diverticular emergencies used to be treated in stages, but more recently there has been a trend towards definitive surgery with immediate resection plus anastomosis under certain conditions. The aim of this study was to define the morbidity and mortality of resection plus anastomosis with on-table antegrade irrigation and of the Hartmann procedure for complicated sigmoid diverticulitis in relation to the type of peritonitis and to the American Society of Anesthesiologists (ASA) grade of the patients. From April 1999 to April 2002, 38 emergency operations for complicated sigmoid diverticulitis were performed at the San Sebastiano Hospital in Caserta. Six patients underwent operations for obstructions and 32 for perforation (19 Hinchley stage III and 13 Hinchley stage IV). Surgical therapy for obstruction consisted in 4 resections plus anastomosis, 1 subtotal colectomy and 1 Hartmann procedure. Surgical therapy for perforation consisted in 14 resections plus anastomosis and 18 Hartmann procedures. There was 1 case (5%) of anastomotic dehiscence out of 19 primary anastomoses versus 2/19 surgical complications (10%) after the Hartmann procedure. The mortality amounted to 1 death out of 38 (2.6%) in a patient treated with the Hartmann procedure. Left-sided colonic obstruction should be treated by resection plus anastomosis or by subtotal colectomy for ASA II-III patients and by Hartmann's procedure for ASA IV-V patients. ASA II-III patients with localised or generalised non-faecal peritonitis should be treated by resection plus anastomosis, while a Hartmann procedure should be the reasonable option for generalised faecal peritonitis and for ASA IV-V patients with localised or generalised non-faecal peritonitis.     

新式保护性肠造口在急诊结肠手术中的应用价值

目的 探讨新式保护性肠造口在急诊结肠手术中的应用价值.方法 回顾性分析16例急诊结肠一期切除吻合术中应用新式保护性肠造口患者的临床资料:回盲部癌合并阑尾穿孔2例;自发性乙状结肠穿孔3例;闭合性腹部外伤致降结肠、乙状结肠广泛挫裂4例;左半结肠癌、乙状结肠癌伴肠梗阻7例.造口方法:回盲部癌伴阑尾穿孔患者,切除末段回肠、部分...     

结肠腹膜后急性穿孔:附20例报告

目的　探讨结肠腹膜后急性穿孔的临床特点。方法　回顾性分析总结 2 0例不同类型的结肠腹膜后穿孔患者的临床资料。结果　 2 0例术前均误诊。 18例行手术治疗 ,其中行癌肿一期切除吻合 5例 ;二期手术结肠切除吻合 5例 ;外伤性穿孔单纯缝合 7例 ,二期结肠吻合 1例 ;死亡 2例。另行保守治疗 2例均死亡。结论　结肠腹膜后急性穿孔与腹腔内穿孔在症状、体征、辅助检查有许多不同之处 ,诊断相对困难 ,误诊率高 ,应予以重视。本病一经诊断 ,应立即行手术治疗。     

急性结直肠癌性梗阻的治疗策略

目的 探讨结直肠癌引起急性肠梗阻的治疗方法.方法 回顾性分析结直肠癌性肠梗阻26例临床资料,复习手术术式及相关文献.结果 右侧结肠梗阻行根治性右半结肠切除术9例.左侧结直肠癌性梗阻17例：12例行一期根治性切除,其中4例行一期吻合,8例行Hartmann术;3例行梗阻近侧结肠造口术;1例直肠癌并升结肠绞窄行右半结肠切除＋乙状结肠造口术;1例拒绝手术.术后2例死于MODS,1例并发炎症性肠梗阻经保守治疗痊愈;病程中合并脓毒性休克、MODS 3例,肺部感染5例,心脏疾病2例;低蛋白血症16例.结论 右侧结肠癌性梗阻可一期切除吻合,左侧结直肠癌性梗阻应遵循损伤控制理论,先行肠减压或清除腹腔炎性渗液,减少毒素吸收以控制病情进一步加重,再根据病情选择有效、安全的术式.术后加强抗感染和营养支持治疗.     

Diverticular disease complicated by peritonitis: role of conservative surgical therapy

Peritonitis complicating diverticular disease may be treated by sigmoid resection (with or without primary anastomosis) or by a conservative surgical approach, either laparoscopically or by open surgery. The choice depends on the severity of the peritonitis (Hinchey), the patient's conditions (ASA) and the surgeon's experience. Sigmoid resection with primary anastomosis has a lower morbidity and mortality vs Hartmann's procedure. After the introduction of laparoscopy in colorectal surgery, exploratory laparoscopy combined with drainage has been proposed to treat acute episodes, followed by laparoscopic resection. Since 1982, over 1000 patients have been operated on for colorectal disease: 119 for complicated diverticulitis, 55 of which complicated by peritonitis. In the latter, we performed conservative surgery (25 patients) and resection (30 patients) laparoscopically or by open surgery. Our results show a higher morbidity and mortality for the Hartmann procedure vs sigmoid resection with primary anastomosis and a lower specific morbidity in patients undergoing laparoscopic exploration and drainage. Moreover, there was a low percentage (52%) of re-canalisations with the Hartmann procedure, with a morbidity of 32% associated with this procedure. In conclusion, we believe that a conservative laparoscopic surgical approach may be advocated in selected cases (Hinchey II and III without clear perforation), followed by laparoscopic sigmoidectomy, resection with primary anastomosis in Hinchey I or in cases of evident perforation with purulent or faecal peritonitis (possibly combined with a stoma), reserving the Hartmann procedure for compromised patients.     

Emergency management of acute colonic cancer obstruction

Emergency management of obstructing colonic cancer depends on both tumor location and stage, general condition of the patient and surgeon's experience. Right sided or transverse colon obstructing cancers are usually treated by right hemicolectomy-extended if necessary to the transverse colon-with primary anastomosis. For left-sided obstructing cancer, in patients with low surgical risk, primary resection and anastomosis associated with on-table irrigation or manual decompression can be performed. It prevents the confection of a loop colostomy but presents the risk of anastomotic leakage. Subtotal or total colectomy allows the surgeon to encompass distended and fecal-loaded colon, and to perform one-stage resection and anastomosis. Its disadvantage is an increased daily frequency of stools. It must be performed only in cases of diastatic colon perforation or synchronous right colonic cancer. In patients with high surgical risk, Hartmann procedure must be preferred. It allows the treatment of both obstruction and cancer, and prevents anastomotic leakage but needs a second operation to reverse the colostomy. Colonic stenting is clinically successful in up to 90% in specialized groups. It is used as palliation in patients with disseminated disease or bridge to surgery in the others. If stent insertion is not possible, loop colostomy is still indicated in patients at high surgical risk.     

急性肿瘤性结肠梗阻的治疗

目的:探讨急性肿瘤性结直肠梗阻的外科处理原则和方法。方法:回顾性分析103例急性肿瘤性结肠梗阻患者的临床资料。结果:全部患者经手术治疗，包括急诊手术80例，其中右半结肠癌25例均行一期切除吻合手术，左半结肠癌45例中一期切除吻合37例，直肠癌10例，均行急诊手术。择期性手术23例。术后发生吻合口瘘3例，肺部感染2例，盆腔感染1例，死亡1例，余均治愈出院。 结论:对于急性肿瘤性结肠梗阻除非有急诊手术指征，应首先采用非手术治疗1～3d，尽可能转为择期性手术；只要恰当掌握适应证，一期肿瘤切除吻合术是比较安全的；对于腹腔污染严重、肠壁穿孔，也应尽可能采用一期切除肿瘤。     

The use of the biofragmentable ring (BAR-Valtrac) in colon surgery

BACKGROUND: Clinical results of colic anastomosis using biofragmentable anastomosis ring (BAR-Valtrac) are presented. Such a method showed to be a real alternative technique to the usual ones. METHODS: Eighty-six colic anastomosis using BAR are collected, 76 of which performed as elective surgery and 10 in emergency. The patients were 47 males and 39 females, with a mean age of 64 years. In 63 cases the patients were affected by colic neoplastic disease, in 16 by complicated diverticular disease (stenosis or perforation) and 7 patients had neoplastic disease of other organs involving the colon BAR device was used in 48 colic reconstructions after segmentary resection and in 38 colic reconstructions after left hemicolectomy. In each case 31-34 mm BAR were used. RESULTS: No perioperative death occurred in our series. Only one case (2%) of anastomotic leak was observed, while in 3 cases (4%) intestinal canalization disorders occurred. No problems for ring expulsion occurred in any patient. Three late complications were observed, as three cases of asymptomatic substenosis discovered during instrumental follow-up and spontaneously cleared up. CONCLUSIONS: On the basis of clinical results, and according to those reported in literature BAR anastomosis is considered a safe, feasible and easy technique to perform colic anastomosis, even in emergency, limited to the intraperitoneal tract of the colon.     

结直肠肿瘤并急性肠梗阻的外科治疗

目的探讨结直肠癌并急性肠梗阻围手术期的处理方法。方法回顾性分析2006年6月至2011年6月收治的97例结直肠肿瘤致急性肠梗阻患者的临床资料。结果 97例均经手术治疗。右半结肠癌伴梗阻32例,其中30例行右半结肠一期切除,无吻合口漏发生,另2例癌肿不能切除行捷径手术;一期左半结肠切除肠吻合术15例,术后发生吻合口漏1例;Hartmann手术13例,术后恢复顺利,造口排便通畅,3～6个月后均进行了顺利关瘘手术;直肠癌Dixon手术27例,低位直肠癌行Miles术10例;行单纯肠造口6例。死亡1例。术后最常见的并发症为切口感染与肺部感染。结论对于结直肠癌并急性发肠梗阻,应根据患者的具体情况决定手术时机及手术方式,左半结肠癌合并肠梗阻可考虑一期切除吻合,但要注意吻合口漏。做好围手术期的处理是减少并发症、降低病死率的关键。     

老年人左半结肠癌并急性肠梗阻Ⅰ期切除吻合疗效观察(附46例报告)

目的 探讨老年人左半结肠癌急性肠梗阻行I期切除吻合手术的临床疗效.方法 对46例老年左半结肠癌急性梗阻患者行急诊I期切除吻合术,术中充分肠道减压和结肠灌洗使肠道空虚、清洁、吻合口双层缝合.结果 无死亡病例,肺部感染6例,切口感染5例,其中2例切口裂开,吻合口瘘2例.结论 左半结肠癌急性梗阻,只要严格掌握手术指征,I期手术是安全有效的.