肿瘤性与非肿瘤性机械性肠梗阻临床诊治的比较研究

doi:10.3760/cma.j.issn.0253-3766.2012.01.013

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题名	肿瘤性与非肿瘤性机械性肠梗阻临床诊治的比较研究
其他题名	Comparison of the diagnosis and treatment of mechanical bowel obstruction due to tumor or other causes
作者	王中林1,2; 潘忠良 1,2; 潘杰1,3; 孙伟 1,2; 徐建敏 1,2; 何杰1,2
发表日期	2012-01-23
发表期刊	中华肿瘤杂志影响因子和分区
语种	中文
原始文献类型	学术期刊
关键词	肠梗阻肿瘤诊断治疗
其他关键词	Intestinal obstruction ; Neoplasms ; Diagnosis ; Treatment
摘要	目的探讨机械性肠梗阻的病因、发病机制,比较肿瘤或非肿瘤所致肠梗阻的治疗方法及预后。方法回顾分析经手术治疗的203例机械性肠梗阻患者的临床资料,其中肿瘤性肠梗阻患者(肿瘤组)73例,其他原因引起的肠梗阻(非肿瘤组)患者130例。结果肿瘤组和非肿瘤组患者性别构成、症状和体征无明显差异,但≥70岁者所占比例(53.4%和35.4%,P=0.012)、既往有腹部手术史者所占比例(23.3%和58.5%,P<0.001)、腹部CT检查病因诊断明确者所占比例(64.4%和44.6%,p=0.011)、m清CEA高于正常值者所占比例(30.1%和4.6%,p<0.001)差异均有统计学意义。肿瘤组58例(79.5%)病变在大肠,12例(16.4%)在小肠;非肿瘤组111例(85.4%)病变在小肠,19例(14.6%)在大肠,差异有统计学意义(P<0.001)。肿瘤组患者共行肠管切除66例(90.4%),肠管造瘘21例(28.8%);非肿瘤组患者行肠管切除61例(46.9%),肠管造瘘5例(3.8%),两组差异均有统计学意义(均P<0.001)。肿瘤组患者住院时间为(18±6)d,长于非肿痛组[(11±3)d,p<0.05]。两组并发症发生率和l术后死亡率差异无统计学意义(均P>0.05)。结论肠道肿瘤引起的机械性肠梗阻多见于老年人、结直肠梗阻或既往无手术史的患者。CT可以提供有效的诊断。肿瘤性肠梗阻患者行于术治疗需要肠管造瘘的比例较高,内镜支架置入是一种安全的选择。
其他摘要	Objective The aim of this study was to review the etiology and pathogenesis of patients who underwent surgery for mechanical bowel obstruction.The treatment and prognosis of bowel obstructions caused by intra-abdominal tumors were compared with those due to other causes.Methods The clinical data of 203 patients with mechanical bowel obstruction undergoing operation were analyzed retrospectively.The tumor cases were classified as group Ⅰ,and all other cases as group Ⅱ.A range of factors were investigated to estimate the postoperative outcome:gender,age,comorbidities,symptoms and findings of physical and radiological examinations, sites of the obstruction, etiology, therapeutic approach,postoperative complications and mortality.Results Group Ⅰ included 73 patients and Group Ⅱ 130.Large bowel carcinoma and peritoneal adhesions were the most common causes of Group Ⅰ and Ⅱ,contributing 58 and 86 of all cases,respectively.There was no significant difference in terms of gender between the two groups,but the rate of elderly ( ≥70 years) patients was significantly higher (53.4％)than that of the ＜70 years old patients (35.4％) (P =0.012).There was a significant difference between the patients with previous surgical operation history in the tumor group (23.3％) and non-tumor group (58.5％)(P ＜0.001 ).In the 73 cases of the tumor group,the obstruction was located in the large bowel in 58 cases (79.5％),small bowel in 12 cases (16.4％),both small and large bowels in 2 cases (2.7％) and gastric cancer invading the splenic flexure of colon in 1 case,while in the non-tumor group,111 cases (85.4％) of the obstruction was located in the small bowel and 19 cases ( 14.6％ ) and in the large bowel ( P ＜ 0.001 ).Sixty-six cases (90.4％) of the tumor-group underwent intestinal segment excision and 21 cases (28.8％)underwent intestinal fistulation in the tumor group,but in the non-tumor group 61 cases (46.9％)underwent intestinal segment excision and 5 cases (3.8％) underwent intestinal fistulation ( all P ＜0.001 ).The hospital stay was ( 18 ± 6) days in the tumor group and ( 11 ± 3 ) days in the non-tumor group ( P ＜0.01).The complication rate (P =0.104) and mortality rate (P =0.187) were not significantly different between the two groups.Conclusions Tumor mechanical bowel obstruction is more frequently seen in patients in elder age,with colorectal location and without previous operation history.CT scan may provide effective diagnosis and ascertain the presence of the malignant obstruction.Intestinal fistulation is more often needed in patients with tumor intestinal obstruction and endoscopic stenting is a safe option in selected patients with tumor intestinal obstruction.
ISSN	0253-3766
卷号	34 期号:01 页码:57-60
DOI	10.3760/cma.j.issn.0253-3766.2012.01.013
页数	0
收录类别	CNKI ; 万方 ; 北大核心 ; PKU ; CSCD ; ISTIC
URL	查看原文
CSCD记录号	CSCD:4456708
引用统计
文献类型	期刊论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/69359
专题	其他_定理临床学院（温州市中心医院）
作者单位	1.温州市第二人民医院; 2.温州医学院定理临床学院普通外科; 3.温州医学院定理临床学院消化内科
第一作者单位	温州医科大学
推荐引用方式 GB/T 7714	王中林,潘忠良,潘杰,等. 肿瘤性与非肿瘤性机械性肠梗阻临床诊治的比较研究[J]. 中华肿瘤杂志,2012,34(01):57-60.
APA	王中林, 潘忠良, 潘杰, 孙伟, 徐建敏, & 何杰. (2012). 肿瘤性与非肿瘤性机械性肠梗阻临床诊治的比较研究. 中华肿瘤杂志, 34(01), 57-60.
MLA	王中林,et al."肿瘤性与非肿瘤性机械性肠梗阻临床诊治的比较研究".中华肿瘤杂志 34.01(2012):57-60.