结肠癌并闭袢性肠梗阻坏死破裂的诊治体会

摘要

目的：探讨结肠癌并闭袢性肠梗阻坏死破裂的病因、诊断与治疗方法。方法：回顾分析2005年5月—2013年5月山东省烟台市北海医院收治的11例结肠癌并闭袢性肠梗阻坏死破裂患者的临床特点和诊治方法。结果：11例患者均有腹痛和停止排便排气、恶心、呕吐症状，其中10例有腹肌紧张，8例有压痛、反跳痛，7例可触及腹部包块，9例腹部X线平片或透视可见肠管扩张及液气平面，10例C T检查可见结肠占位和近端肠管扩张积气。经急诊手术治疗后9例治愈，2例因感染性休克、多脏器功能衰竭死亡。结论：结肠癌并闭袢性肠梗阻是肠梗阻的特殊类型，其特点是发病急，病情重，进展快，早期即出现腹膜炎和严重感染性休克。只有做到早发现、早诊断、早手术治疗，才能挽救患者的生命。%Objective:To explore the etiology ,diagnosis and treatment of colon cancer complicated by closed loop obstruction necrosis and rupture .Methods:The clinical feature ,diagnosis and treatment of 11 patients with colon cancer complicated by closed loop obstruction necrosis and rupture ,who were admitted to Yantai Beihai Hospital during May 2005 and May 2013 , were retrospectively analyzed .Results:All the 11 patients had abdominal pain ,defecation stop ,exhaust close ,nausea and vomit .Among them ,there were 10 cases of abdominal rigidity ,8 cases of tenderness and rebound tenderness ,7 cases of palpable abdominal mass ,9 cases of bowel dilatation and air‐fluid level found by abdominal X‐ray plain film ,10 cases of colon occupying and proximal bowel dilatation found by CT examination .And 9 patients were cured by surgical operation ,while 2 patients died of septic shock and multiple organ failure .Conclusions:Colon cancer complicated by closed loop obstruction is a special type of obstruction ,which is characterized by acute onset ,severe status ,rapid progress ,early emerged peritonitis and serious septic shock .Early detection ,early diagnosis ,and early surgical treatment can make the greatest effort to save the patient’s life .