CAJ | 학술논문

目的：探讨结肠癌急诊的围手术期管理及预后。方法回顾性分析收治73例结肠癌急症病例的临床资料。结果术前明确诊断29例，占39.7%。一期吻合29例，切除肿瘤、腹壁造口37例，姑息性造口7例，术后死亡3例，包括一期吻合后吻合口瘘1例，35例次出现并发症。吻合口瘘4例，占一期吻合的13.8%，其余瘘口闭合痊愈出院。切口皮下积液、感染13例，占17.8%，切口全层裂开6例，占8.2%，肺部感染、肺不张4例，占5.4%，3例痊愈，1例转入呼吸内科监护室后痊愈。菌群失调致腹泻5例，占6.8%。泌尿系感染3例，占5.4%，保守治疗后症状消失。脑梗1例，占1.37%。7例带瘤患者中，5例存活期<12个月，2例存活期为12~18个月。结论正确认识结肠癌急症的临床意义，详细采集病史、体格检查、研读辅助检查结果，个性化制订诊疗方案，采取合理外科学处理策略，减少病死率、提升生活质量。
목적：탐토결장암급진적위수술기관리급예후。방법회고성분석수치73례결장암급증병례적림상자료。결과술전명학진단29례，점39.7%。일기문합29례，절제종류、복벽조구37례，고식성조구7례，술후사망3례，포괄일기문합후문합구루1례，35례차출현병발증。문합구루4례，점일기문합적13.8%，기여루구폐합전유출원。절구피하적액、감염13례，점17.8%，절구전층렬개6례，점8.2%，폐부감염、폐불장4례，점5.4%，3례전유，1례전입호흡내과감호실후전유。균군실조치복사5례，점6.8%。비뇨계감염3례，점5.4%，보수치료후증상소실。뇌경1례，점1.37%。7례대류환자중，5례존활기<12개월，2례존활기위12~18개월。결론정학인식결장암급증적림상의의，상세채집병사、체격검사、연독보조검사결과，개성화제정진료방안，채취합리외과학처리책략，감소병사솔、제승생활질량。
Objective To investigate the diagnosis,surgical treatment,perioperative management and prognosis of emergency patients with colon cancer. Methods The clinical data of 73 emergency pa-tients with colon cancer were analyzed retrospectively. Result There were 29 cases(39. 7% )with con-firmed preoperative diagnosis. There were 29 cases of primary anastomosis,37 cases of tumor resection and colostomy and 7 cases of palliative colostomy. Postoperative death occurred in 3 cases,including 1 case of anastomotic fistula after primary anastomosis. There were 35 person-times of complications. Anastomotic fistula occurred in 4 cases,accounting for 13. 8% of the patients with primary anastomosis. The rest fistula was closured and recovered. Incisional subcutaneous effusion and infection occurred in 13 cases(17. 8% ). Full-thickness wound disruption occurred in 6 cases(8. 2% ). Lung infection and atelectasis occurred in 4 cases(5. 4% ). Three cases of them recovered but 1 case was transferred to respiratory intensive care unit and got cured. Dysbacteriosis and diarrhea occurred in 5 cases(6. 8% ). Urinary tract infection occurred in 3 cases(5. 4% )and the symptoms disappeared after conservative treatment. Cerebral infarction occurred in 1 case(1. 37% ). In the 7 survivors with tumors,5 of them survived less than 12 months and the other 2 cases' survival time was 12 to 18 months. Conclusion Correct understanding of the clinical significance, collection of the detailed medical history,physical examination and assistant examination results,individu-alized diagnosis and treatment plan and reasonable surgical treatment strategy can reduce the mortality and improve the quality of life in of emergency patients with colon cancer.