Ammaturo C, Cirillo F, Imperatore F, Morra C, D'Eliso E, Cammarota A, Giardiello C, Vecchio G
Divisione di Chirurgia d'Urgenza, USL 44, Ospedale Loreto Mare, Napoli.
Minerva Chir. 1996 Jun;51(6):433-8.
The authors report their experience, matured in 10 years, in the management of cancer of the rectum and large bowel complicated by obstruction; 425 patients out of 493 total cases of colorectal cancer presented an intestinal obstruction and underwent emergency surgery. In 386 cases it was possible to perform resection (91%). The surgical treatment of the patients with right colon obstruction usually consisted of a right hemicolectomy. The surgical treatment of left colon obstruction is still controversial; in the experience of the authors it was accomplished by Hartmann operation mainly until 1985; in recent years the authors have introduced a procedure of intraoperative anterograde irrigation of the colon and they have performed resection-anastomosis in a single stage successfully but only in selected patients. In 4 out of twelve cases of cancer of the splenic flexure a subtotal colectomy was performed with one stage ileo-sigmoid anastomosis crowned with success. The authors examine the operative and postoperative mortality of the patients with colorectal cancer and point out that 5 years survival is worse in patients with colorectal obstruction compared to elective operations (24% versus 41%).
作者报告了他们在10年中积累的处理直肠癌和大肠癌症并发肠梗阻的经验；在493例结直肠癌病例中，有425例出现肠梗阻并接受了急诊手术。在386例病例中可行切除手术（91%）。右半结肠癌梗阻患者的手术治疗通常包括右半结肠切除术。左半结肠癌梗阻的手术治疗仍存在争议；据作者经验，直到1985年主要通过哈特曼手术完成；近年来，作者引入了术中结肠顺行灌洗程序，并仅在选定患者中成功进行了一期切除吻合术。在12例脾曲癌病例中，4例进行了全结肠次全切除术并成功进行了一期回肠-乙状结肠吻合术。作者检查了结直肠癌患者的手术及术后死亡率，并指出与择期手术相比，结直肠癌梗阻患者的5年生存率较差（分别为24%和41%）。
