tory burch handbags Of rectal cancer Surgical trea

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Of rectal cancer Surgical treatment of acute intestinal obstruction

Abstract Objective cancer Surgical treatment of acute intestinal obstruction experience. Methods Retrospective analysis of hospital Jul. 1995 ~ July 2005 23 patients with rectal cancer were admitted with acute intestinal obstruction in the clinical data. Results Of the 23 patients, Hartmann procedure in 9 cases, Dixon operation in 12 cases, tumors proximal intestine simple colostomy in 2 cases. Postoperative complications in 4 cases (17.4%), wound infection in 2,[link widoczny dla zalogowanych], anastomotic leakage in 2 cases, no deaths. Conclusions Acute intestinal obstruction caused by rectal cancer and choice of surgical procedure should be followed: to save lives, relieve obstruction, to remove the tumor, the principle of improving the quality of life of patients, the actual processing, based on the general condition of the patient and the bowel, tumor local circumstances.
Key words cancer; intestinal obstruction; a bowel resection and anastomosis
Cancer complicated with acute obstruction is the clinical manifestation of advanced rectal cancer, surgery is one of common acute abdomen [1]. Onset occult cancer as early non-specific clinical manifestations, often misdiagnosed as haemorrhoids, delayed treatment of chronic colitis. As well as acute intestinal obstruction, treatment is very difficult, if appropriate treatment is directly related to the prognosis of patients. Hospital in July 1995 ~ July 2005 rectal cancer were treated and 23 patients with acute intestinal obstruction. These are as follows.
1 Materials and Methods
1.1 GENERAL The group of 23 patients, 14 male and 9 female; aged 25 to 85 years, mean 59 years. Have abdominal pain, bloating, anal stop exhaust, defecation with varying degrees of nausea and vomiting symptoms of acute obstruction. Some patients with a history of recurrent abdominal distention not, change in bowel habits, scheduling mucus,[link widoczny dla zalogowanych], and a history of bloody mucus. Time of obstruction 8h ~ 5 days, an average of 3 days.
1.2 In addition to routine preoperative abdominal X-ray examination, the colonoscopy should be OK, or barium enema to clear of obstruction and its nature, this group of 23 patients underwent Li bit abdominal plain film, were showing the performance of different degrees of bowel obstruction, 13 cases (56.5%) had swelling of the colon loop expansion; 3 routine barium enema, were observed in luminal stenosis; 16 cases (69.6%) underwent colon fiber microscopy, lumen stenosis were observed in 14 patients colonoscopy can not stricture; CT examination confirmed one case of rectal cancer. Diagnosed with colorectal cancer before surgery in 20 cases (86.9%), there are three cases of preoperative diagnosis for other causes of intestinal obstruction after colorectal cancer proved by laparotomy.
1.3 preoperative preparation (1) continuous gastrointestinal decompression. (2) to correct fluid and electrolyte disorders and acid-base balance of hypoproteinemia, supplementary blood volume. (Three) to control blood pressure and blood sugar to normal levels. (4) infection control: use of preoperative intravenous antibiotics, surgery when an additional 1 more than 2h, select the anti-anaerobic bacteria and gram-negative bacilli based antibiotics. (5) for bowel preparation: low pressure enema clean the following bowel obstruction, complete obstruction against enema and oral antibiotics, incomplete intestinal obstruction proper lubrication of oral laxative mineral oil, but disable the mannitol and magnesium sulfate.
1.4 are in operation in the surgical line of obstruction by the proximal colon bowel decompression and / or lavage. Hartmann operation in 9 cases, Dixon operation in 12 cases, tumors proximal intestine simple colostomy in 2 cases. Completion of routine anal surgery to 3 to 4 refers to anal sphincter relaxation in the state.
1.5 after treatment to maintain water and electrolyte balance; intravenous use of antibiotics in 5 to 7 days for parenteral nutrition (TPN) support; postoperative early stage, fully expanded anus to reduce the impact of anastomosis.
2 Results
Postoperative complications in 4 cases (17.4%): 2 cases of wound infection, anastomotic fistula in 2 cases. Hartmann operation of which 9 cases, wound infection in 1 case; Dixon surgery in 12 cases of anastomotic leakage in 2 cases; tumor proximal bowel ostomy wound infection 1 case alone, with no deaths. Cancer in the peritoneal fold or more in 18 cases, fold in the following five cases of peritoneal tumor from the anus under the shortest margin of 5cm, Dukes stage: B of 6 cases, C of 15 cases, D of 2 cases. Pathological types: adenocarcinoma in 13 cases, eight cases of mucinous carcinoma, undifferentiated carcinoma in 2 cases.
3 discussion
With the continuous improvement of the diagnosis more colorectal cancer may be in the event of acute obstruction before treatment, the incidence of acute obstruction of the decline [2], rectal cancer mortality and disease progression and surgical correlation. Colorectal cancer often lead to acute obstruction and atypical clinical features as regular visits delay time, when the doctor has reached a critical condition,[link widoczny dla zalogowanych], increasing the difficulty of surgical treatment.
With acute intestinal cancer is a serious complication of advanced cancer of the literature showed an incidence of large bowel obstruction in cancer caused by the lowest, about 9.3% to 15.0% [3 ], which may be larger rectal lumen, the proportion of low rectal cancer infiltrating the. Compared with western countries, China's proportion of colorectal cancer are more (60% to 75%) of intestinal obstruction caused by colorectal cancer incidence may be higher. Rectal obstruction combined with more specific features of the pathophysiology: (1) the presence of the ileocecal valve, usually caused by mechanical, closed loop of low intestinal obstruction. Obstruction if not timely removed, it has led to colon necrosis and perforation risk. (2) contains a lot of bacteria within the colon, intestinal mucosal barrier after damage to susceptible bacterial translocation, leading to sepsis or septic shock. (3) Patients are often older, more associated with cardiopulmonary and other vital organs of internal diseases, intestinal obstruction in the event it is often rapid deterioration of general condition, clinical management is difficult, complications and mortality is high, is a surgical treatment challenge.
Cancer once diagnosed with acute intestinal obstruction, gastrointestinal decompression should be positive for anti-infection, to correct the water, electrolyte balance disorder, under the close observation of non-surgical treatment. Leading cause of intestinal obstruction for cancer, now there were two new non-surgical treatment, the central objective is to first lift the obstruction, the patient changes from a non-emergency state of emergency to gain valuable time to improve the general condition of patients to evaluate the state of tumor progression and for patients bowel preparation, the emergency operation into a period of operation, improve the treatment outcome and reduce complications. Non-surgical treatments currently used two new technologies: self-expanding stent placement and decompression by rectal tube type intestinal obstruction. In 1991, Dohmoto first reported the use of metal stents for colorectal obstruction of [4]. Subsequent proved stent bowel obstruction caused by colorectal cancer is simple and effective, and has the advantages of minimally invasive. Yokohata such report eight cases of obstruction of the rectum and sigmoid colon cancer patients treated by catheter obstruction in 7 cases after the completion of a radical resection and anastomosis, no anastomotic leakage occurred; one case of the line because of unresectable sigmoid colostomy [5]. These two techniques has not been extensively. Can relieve symptoms such as obstruction, adequate bowel preparation may be doing underwent for elective surgery. If, after 8 ~ 72h of observation and treatment, no significant improvement of symptoms but gradually worsened, treatment should be as early as possible.
Emergency surgery, should be based on the general condition of patients and intraoperative circumstances a reasonable surgical choice. Generally believed that, if surgery can detect tumor excision, the surgical procedure can have two: one stage resection and removal. One stage resection surgery and Dixon also includes Hartmann surgery two. Right colon resection and anastomosis have been feasible a basic consensus to left colon cancer because the intestinal wall thin, muscular underdevelopment, poor blood circulation, healing ability, a high degree of expansion of intestinal obstruction, edema, accumulation of feces a lot,[link widoczny dla zalogowanych], high levels of bacteria, significant differences between colorectal anastomosis diameter, difficult pelvic operations and other factors, whether a resection and anastomosis should be, as the case may be. For shorter obstruction, intestinal expansion,[link widoczny dla zalogowanych], edema was not obvious, intestinal blood flow is better, practical one-stage resection (Dixon surgery). For a long time obstruction, intestinal expansion, edema, poor blood circulation intestine, can choose Hartmann surgery.
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