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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。
Objective To investigate the perioperative management and prognosis of colon cancer patients. Methods Retrospective analysis of 73 cases of colon cancer emergency cases of clinical data. Results preoperative diagnosis of 29 cases, accounting for 39.7%. One case was anastomosed with 29 cases. Tumor resection was performed in 37 cases of abdominal stoma, 7 cases of palliative stoma, 3 cases of postoperative death, including 1 case of anastomotic fistula after anastomosis and 35 cases of complications. Anastomotic fistula in 4 cases, accounting for 13.8% of anastomosis, closed the rest of the fistula was discharged. Incision subcutaneous fluid infection in 13 cases, accounting for 17.8%, incision full-thickness split in 6 cases, accounting for 8.2%, pulmonary infection, atelectasis in 4 cases, accounting for 5.4%, 3 recovered, 1 case transferred to respiratory medicine After the room healed. Flora caused by diarrhea in 5 cases, accounting for 6.8%. Urinary tract infection in 3 cases, accounting for 5.4%, symptoms disappeared after conservative treatment. 1 case of cerebral infarction, accounting for 1.37%. Of the 7 patients with tumor, 5 had a survival of <12 months and 2 had a survival of 12 to 18 months. Conclusions Correct understanding of the clinical significance of colon cancer emergency, detailed medical history, physical examination, study assistant examination results, personalized development of treatment programs, to take reasonable surgical treatment strategies to reduce mortality and improve quality of life.