目的 总结结肠癌合并腹腔脓肿的临床特征、术前检查及治疗方法.方法 回顾性分析2008年1月至2014年8月福建医科大学附属龙岩第一医院收治的41例结肠癌并发腹腔脓肿患者的临床资料.患者术前行实验室和影像学检查.根据肿瘤根治性及手术安全性原则,41例患者均行开腹手术治疗,术后予补液、抗生素、静脉营养支持及对症治疗.采用电话和门诊方式进行随访,随访时间截至2014年8月.结果 41例患者入院时均有不同程度的肠梗阻及感染症状,合并糖尿病26例,高血压病21例,心脏疾病19例,慢性阻塞性肺病9例.实验室检查结果:Hb ＜60 g/L 4例,60 ～ 90 g/L 28例,＞90 g/L 9例;血Alb＜ 30 g/L 36例;糖化血红蛋白升高患者18例;血清降钙素原升高患者41例;血CEA值升高患者10例.41例患者术前行胸腹部增强CT检查,可见腹腔肿瘤及肠梗阻等影像学表现.23例患者行电子肠镜检查均可见肠腔内肿瘤,19例患者肠镜无法通过,其中2例行肠镜下金属支架置入术解除梗阻.28例患者行诊断性腹腔镜穿刺获取脓液标本,13例患者于术中获取脓液标本,共培养出59株细菌,以大肠埃希菌为主占61.0％ (36/59),对亚胺培南敏感.41例患者均行开腹手术治疗,其中33例同时行肠造口术,平均手术时间为221 min(150 ～272 min),术中平均出血量为370 mL(100～800 mL).患者肿瘤位于回盲部6例、升结肠9例,行姑息性或根治性右半结肠切除术;肿瘤位于结肠肝曲2例行根治性扩大右半结肠切除术;肿瘤位于结肠脾曲4例、降结肠7例,均行根治性切除及末端回肠造口术;肿瘤位于乙状结肠13例,12例行根治性切除术、1例行姑息性切除术.术后并发症:肺部感染11例,切口感染或全层裂开6例,吻合口漏5例,输尿管损伤4例,心衰竭4例,术后麻痹性肠梗阻3例,败血症2例,肾衰竭1例,脑梗死1例,肺栓塞1例(同一患者可合并多种术后并发症).术后9例患者死亡.手术切除的肿瘤平均直径为9.4 cm(4.5 ～15.0 cm).高分化肿瘤25例,中分化肿瘤12例,低分化肿瘤4例(印戒细胞癌1例).肿瘤T分期:T3期4例,T4或T4b期37例.每例患者平均清扫淋巴结数目为23枚(15 ～ 35枚),阳性淋巴结共18枚.6例患者发生淋巴结转移.28例患者获得随访.中位随访时间为27个月(3～ 80个月).16例患者随访期间死亡,其中10例死于肿瘤复发、转移,6例死于其他疾病.12例患者生存,其中4例出现复发转移,8例未发现明显复发转移.结论 结肠癌合并腹腔脓肿患者多为合并多种内科疾病的高龄患者,患者病死率高.手术治疗是唯一可能治愈的治疗措施,应做好准确的术前评估,把握手术时机,术中应避免损伤输尿管、血管等周围重要结构;联合肠造口术减少吻合口相关并发症,术后常规腹腔冲洗,根据药物敏感试验使用抗生素,可减少术后并发症,降低病死率.
目的 總結結腸癌閤併腹腔膿腫的臨床特徵、術前檢查及治療方法.方法 迴顧性分析2008年1月至2014年8月福建醫科大學附屬龍巖第一醫院收治的41例結腸癌併髮腹腔膿腫患者的臨床資料.患者術前行實驗室和影像學檢查.根據腫瘤根治性及手術安全性原則,41例患者均行開腹手術治療,術後予補液、抗生素、靜脈營養支持及對癥治療.採用電話和門診方式進行隨訪,隨訪時間截至2014年8月.結果 41例患者入院時均有不同程度的腸梗阻及感染癥狀,閤併糖尿病26例,高血壓病21例,心髒疾病19例,慢性阻塞性肺病9例.實驗室檢查結果:Hb ＜60 g/L 4例,60 ～ 90 g/L 28例,＞90 g/L 9例;血Alb＜ 30 g/L 36例;糖化血紅蛋白升高患者18例;血清降鈣素原升高患者41例;血CEA值升高患者10例.41例患者術前行胸腹部增彊CT檢查,可見腹腔腫瘤及腸梗阻等影像學錶現.23例患者行電子腸鏡檢查均可見腸腔內腫瘤,19例患者腸鏡無法通過,其中2例行腸鏡下金屬支架置入術解除梗阻.28例患者行診斷性腹腔鏡穿刺穫取膿液標本,13例患者于術中穫取膿液標本,共培養齣59株細菌,以大腸埃希菌為主佔61.0％ (36/59),對亞胺培南敏感.41例患者均行開腹手術治療,其中33例同時行腸造口術,平均手術時間為221 min(150 ～272 min),術中平均齣血量為370 mL(100～800 mL).患者腫瘤位于迴盲部6例、升結腸9例,行姑息性或根治性右半結腸切除術;腫瘤位于結腸肝麯2例行根治性擴大右半結腸切除術;腫瘤位于結腸脾麯4例、降結腸7例,均行根治性切除及末耑迴腸造口術;腫瘤位于乙狀結腸13例,12例行根治性切除術、1例行姑息性切除術.術後併髮癥:肺部感染11例,切口感染或全層裂開6例,吻閤口漏5例,輸尿管損傷4例,心衰竭4例,術後痳痺性腸梗阻3例,敗血癥2例,腎衰竭1例,腦梗死1例,肺栓塞1例(同一患者可閤併多種術後併髮癥).術後9例患者死亡.手術切除的腫瘤平均直徑為9.4 cm(4.5 ～15.0 cm).高分化腫瘤25例,中分化腫瘤12例,低分化腫瘤4例(印戒細胞癌1例).腫瘤T分期:T3期4例,T4或T4b期37例.每例患者平均清掃淋巴結數目為23枚(15 ～ 35枚),暘性淋巴結共18枚.6例患者髮生淋巴結轉移.28例患者穫得隨訪.中位隨訪時間為27箇月(3～ 80箇月).16例患者隨訪期間死亡,其中10例死于腫瘤複髮、轉移,6例死于其他疾病.12例患者生存,其中4例齣現複髮轉移,8例未髮現明顯複髮轉移.結論 結腸癌閤併腹腔膿腫患者多為閤併多種內科疾病的高齡患者,患者病死率高.手術治療是唯一可能治愈的治療措施,應做好準確的術前評估,把握手術時機,術中應避免損傷輸尿管、血管等週圍重要結構;聯閤腸造口術減少吻閤口相關併髮癥,術後常規腹腔遲洗,根據藥物敏感試驗使用抗生素,可減少術後併髮癥,降低病死率.
목적 총결결장암합병복강농종적림상특정、술전검사급치료방법.방법 회고성분석2008년1월지2014년8월복건의과대학부속룡암제일의원수치적41례결장암병발복강농종환자적림상자료.환자술전행실험실화영상학검사.근거종류근치성급수술안전성원칙,41례환자균행개복수술치료,술후여보액、항생소、정맥영양지지급대증치료.채용전화화문진방식진행수방,수방시간절지2014년8월.결과 41례환자입원시균유불동정도적장경조급감염증상,합병당뇨병26례,고혈압병21례,심장질병19례,만성조새성폐병9례.실험실검사결과:Hb ＜60 g/L 4례,60 ～ 90 g/L 28례,＞90 g/L 9례;혈Alb＜ 30 g/L 36례;당화혈홍단백승고환자18례;혈청강개소원승고환자41례;혈CEA치승고환자10례.41례환자술전행흉복부증강CT검사,가견복강종류급장경조등영상학표현.23례환자행전자장경검사균가견장강내종류,19례환자장경무법통과,기중2례행장경하금속지가치입술해제경조.28례환자행진단성복강경천자획취농액표본,13례환자우술중획취농액표본,공배양출59주세균,이대장애희균위주점61.0％ (36/59),대아알배남민감.41례환자균행개복수술치료,기중33례동시행장조구술,평균수술시간위221 min(150 ～272 min),술중평균출혈량위370 mL(100～800 mL).환자종류위우회맹부6례、승결장9례,행고식성혹근치성우반결장절제술;종류위우결장간곡2례행근치성확대우반결장절제술;종류위우결장비곡4례、강결장7례,균행근치성절제급말단회장조구술;종류위우을상결장13례,12례행근치성절제술、1례행고식성절제술.술후병발증:폐부감염11례,절구감염혹전층렬개6례,문합구루5례,수뇨관손상4례,심쇠갈4례,술후마비성장경조3례,패혈증2례,신쇠갈1례,뇌경사1례,폐전새1례(동일환자가합병다충술후병발증).술후9례환자사망.수술절제적종류평균직경위9.4 cm(4.5 ～15.0 cm).고분화종류25례,중분화종류12례,저분화종류4례(인계세포암1례).종류T분기:T3기4례,T4혹T4b기37례.매례환자평균청소림파결수목위23매(15 ～ 35매),양성림파결공18매.6례환자발생림파결전이.28례환자획득수방.중위수방시간위27개월(3～ 80개월).16례환자수방기간사망,기중10례사우종류복발、전이,6례사우기타질병.12례환자생존,기중4례출현복발전이,8례미발현명현복발전이.결론 결장암합병복강농종환자다위합병다충내과질병적고령환자,환자병사솔고.수술치료시유일가능치유적치료조시,응주호준학적술전평고,파악수술시궤,술중응피면손상수뇨관、혈관등주위중요결구;연합장조구술감소문합구상관병발증,술후상규복강충세,근거약물민감시험사용항생소,가감소술후병발증,강저병사솔.
Objective To summarize the clinical characteristics,preoperative examinations and therapeutic method of colon cancer combined with abdominal abscess.Methods The clinical data of 41 patients with colon cancer combined with abdominal abscess who were admitted to the First Hospital of Longyan between January 2008 and August 2014 were retrospectively analyzed.All the patients underwent laboratory tests and imaging examinations before operation.According to the principles of operative safety and radical resection of tumor,41 patients underwent open operation and then received the fluid infusion,antibiotic treatment,parenteral nutrition support and symptomatic treatment after operation.Patients were followed up via telephone interview and outpatient examination till August 2014.Results All the 41 patients had different levels of obstruction and infection at admission,and concomitant diabetes mellitus were detected in 26 patients,essential hypertension in 21 patients,heart diseases in 19 patients and chronic obstructive pulmonary disease in 9 patients.The results of laboratory tests showed that there were 4 patients with hemoglobin (Hb) ＜60 g/L,28 patients with the level of Hb between 60 g/L and 90 g/L,9 patients with Hb ＞90 g/L,36 patients with albumin (Alb) ＜ 30 g/L,18 patients with increased glycosylated hemoglobin (GHb),41 patients with increased serum procalcitonin and l0 patients with increased blood carcinoembryonic antigen (CEA).Abdominal tumors and intestinal obstructions were detected in 41 patients by thoracic and abdominal enhanced CT,intraluminal tumors in 23 patients by colonoscopy because of unsuccessful placement of colonoscopy in 19 patients,the metal stent endoprosthesis was placed in 2 patients to relieve obstruction.Fifty-nine strains of bacteria were cultured from 41 copies of the pus (28 copies obtained from diagnosistic peritoneocentesis and 13 copies obtained from operation),and most of them were escherichia coli with a percentage of 61.0％ (36/59) and were sensitive to imipenem.All patients underwent open surgery including 33 patients combined wtih enterostomy.The operation time was 150-272 minutes with a median time of 221 minutes.The volume of intraoperative blood loss was 100-800 mL with a median volume of 370 mL.The tumor located at the ileocecal valve was detected in 6 patients and ascending colon in 9 patients,and then palliative or radical right hemicolectomy was performed.The tumor located at the hepatic flexure of colon was detected in 2 patients and then radical extended right hemicolectomy was performed.The tumor located at the splenic flexure was detected in 4 patients and descending colon in 7 patients,and then the radical resection and terminal ileostomy were performed.Among 13 patients with tumor located at the sigmoid colon,12 patients received radical resection and 1 patient received palliative resection.Eleven patients were complicated with pulmonary infection,6 patients with infection or dehiscence of incision,5 patients with anastomotic leakage,4 patients with ureteral injury,4 patients with heart failure,3 patients with paralytic intestinal obstruction,2 patients with septicemia,1 patient with renal failure,1 patient with cerebral infarction and 1 patient with pulmonary embolism.Nine patients died after operation.The diameter of resected tumor was 4.5-15.0 cm with a median diameter of 9.4 cm.High-differentiated tumors were detected in 25 patients,moderate-differentiated tumors in 12 patients and low-differentiated tumors in 4 patients (signet-ring cell carcinoma in l patient).There were 4 patients in the T3 stage of tumor and 37 patients in the T4 or T4b stage.The number of lymph node dissection was 23 (range,15-35) with 18 positive lymph nodes.Six patients had lymph node metastasis.Twenty-eight patients were followed up for a median time of 27 months (range,3-80 months).During the follow-up,16 patients died and 12 patients survived,10 patients died of tumor recurrence and metastasis,6 patients died of other diseases,4 patients had tumor recurrence and metastasis and 8 patients had no recurrence and metastasis.Conclusions Patients with colon cancer combined with abdominal abscess are usually complicated with internal diseases,with a high mortality.Surgical treatment is the only curative treatment option,but an accurate preoperative evaluation is essential and the opportunity of operation should be evaluated before operation,the injury of ureteral,vascular and other surrounding important structures should be avoided during operation,meanwhile,intraoperative application of enterostomy could reduce anastomosis-related complications.After operation,routine peritoneal lavage and antibiotics according to the drug sensitive test are conducted for reducing the postoperative complications and mortality.
