Fitchett C W, Hoffman G C
Surg Clin North Am. 1986 Aug;66(4):807-20. doi: 10.1016/s0039-6109(16)43992-7.
Evidence has been presented to suggest that the patient with an obstructed carcinoma of the colon may have a more malignant form of the disease independent of lymph node status or tumor encirclement of the bowel. Rate of tumor growth is never consistent in patients with this disease. Patients who develop colon obstruction early in the course of the disease seem to have more aggressive tumors with rapid growth and a much poorer long-term prognosis. Perforations frequently accompany obstructions of the colon. Patients in this group have a dismal prognosis. Individuals with obstructed carcinoma of the colon have a higher operative mortality and morbidity and a shorter long-term survival. The higher operative mortality and morbidity may depend entirely on the choice of operative procedures. Tumor location affects prognosis. Obstructing tumors in the left colon have a more favorable prognosis than those in the right colon. Obstructing right colon tumors have a much poorer survival (three times worse) than nonobstructing carcinomas of the right colon. Obstructing tumors in the rectum have a very poor prognosis. Evidence exists that resection of the tumor without preliminary proximal decompression may reduce hospital mortality and morbidity and increase long-term survival. In selected cases, primary resection can be done as safely as staged operative procedures. Primary anastomosis with resection of the left colon carries a higher operative mortality because of anastomotic leaks. Resection without anastomosis is much safer. Primary resection with anastomosis is the procedure of choice in obstructing lesions of the right colon. This has a lower operative mortality and morbidity than a staged procedure. This primary resection with anastomosis is certainly as safe as an ileotransverse colostomy. It is important not to abandon the time-honored surgical principle of never suturing obstructed bowel. Primary resection without anastomosis confirms this surgical principle. Meticulous preoperative and postoperative care employing physiological monitoring, multiple antibiotics, total parenteral hyperalimentation, and respiratory and circulatory support will further reduce the hospital mortality and morbidity. Patients who initially appear to be obstructed on barium enema, but who in truth are only partially obstructed, can be properly managed so that an elective primary resection with anastomosis can be done with the same operative mortality and morbidity as in other elective colon cancer patients.
已有证据表明，患有结肠癌梗阻的患者可能患有更恶性的疾病形式，这与淋巴结状态或肿瘤对肠管的包绕无关。该疾病患者的肿瘤生长速度并不一致。在疾病早期就出现结肠梗阻的患者似乎患有更具侵袭性的肿瘤，生长迅速，长期预后较差。穿孔常伴随结肠梗阻出现。该组患者预后不佳。患有结肠癌梗阻的个体手术死亡率和发病率较高，长期生存率较低。较高的手术死亡率和发病率可能完全取决于手术方式的选择。肿瘤位置会影响预后。左半结肠的梗阻性肿瘤预后比右半结肠的梗阻性肿瘤更有利。右半结肠梗阻性肿瘤的生存率比非梗阻性右半结肠癌差得多（差三倍）。直肠梗阻性肿瘤预后极差。有证据表明，在没有进行初步近端减压的情况下切除肿瘤可能会降低医院死亡率和发病率，并提高长期生存率。在某些情况下，一期切除可以与分期手术一样安全地进行。左半结肠切除并一期吻合由于吻合口漏导致手术死亡率较高。不进行吻合的切除要安全得多。右半结肠梗阻性病变的首选手术方式是一期切除并吻合。与分期手术相比，其手术死亡率和发病率较低。这种一期切除并吻合肯定与回肠横结肠造口术一样安全。重要的是不要放弃不缝合梗阻肠管这一由来已久的手术原则。不进行吻合的一期切除证实了这一手术原则。采用生理监测、多种抗生素、全胃肠外营养以及呼吸和循环支持的精心术前和术后护理将进一步降低医院死亡率和发病率。最初在钡剂灌肠时看似梗阻但实际上只是部分梗阻的患者，可以得到妥善处理，以便进行择期一期切除并吻合，其手术死亡率和发病率与其他择期结肠癌患者相同。
