目的探讨左半结肠癌并发急性肠梗阻一期切除吻合的合理性与评价。方法回顾性分析我院1994年2月期间至2003年2月采用一期切除吻合术治疗左半结肠癌并发急性肠梗阻64例的临床资料。结果全组患者无死亡及腹腔感染。7例(10.9%)发生切口感染，3例(4.7%)发生吻合口漏，均治愈。住院时间10~36 d，平均16 d。结论部分经选择的病例中开展一期切除吻合术是安全、可行的，选择性应用一期切除吻合术是治疗左半结肠癌并发急性肠梗阻的理想术式。
目的探讨老年急性肠梗阻的临床特点及其治疗，寻找降低死亡率的有效方法。方法回顾性总结分析150例经手术证实的60岁以上的急性肠梗阻患者的病因、临床特点及其治疗方法。结果引起肠梗阻的病因中，肿瘤75例(50.0%)，肠粘连27例(18.0%)，腹外疝11例(7.3%)，肠扭转10例(6.7%)，其它原因导致梗阻27例（18.0%）。绞窄性肠梗阻34例，术后有并发症35例，死亡12例。结论老年急性肠梗阻的主要病因为肿瘤，加强围手术期处理、重视老年合并疾病、早期诊断及手术可有效减低术后死亡率。
ObjectiveThe aim of this current meta-analysis is to evaluate the efficacy and safety of selective surgery after colonic stenting versus emergency surgery for acute obstructive colorectal cancer.MethodsThe studies published from January 1, 2000 to July 31, 2018 were searched from Pubmed, Embase, Cochrane Library, CNKI, Wanfang database, and VIP database. RevMan 5.3 software was used for data analysis.ResultsA total of 21 studies were included in this meta-analysis. Compared to emergency surgery, selective surgery after colonic stenting had significant lower mortality rate [OR=0.44, 95% CI was (0.26, 0.73), P<0.05], permanent stoma rate [OR=0.46, 95% CI was (0.23, 0.94), P<0.05], complication rate [OR=0.47, 95% CI was (0.35, 0.63), P<0.05], and wound infection rate [OR=0.40, 95% CI was (0.25, 0.65), P<0.05）], but had significant higher primary anastomosis rate [OR=3.30, 95% CI was (2.47, 4.41), P<0.05] and laparoscopic surgery rate [OR=12.55, 95% CI was (3.64, 43.25), P<0.05]. But there was no significant differences between the two groups as to anastomotic leak rate [OR=0.86, 95% CI was (0.48, 1.55), P>0.05].ConclusionsSelective surgery after colonic stenting can be identified in a reduced incidence of mortality rate, complication rate, permanent stoma rate, and wound infection rate, and also can increase primary anastomosis rate and laparoscopic surgery rate. Thus, for acute obstructive colorectal cancer, selective surgery after colonic stenting is better than emergency surgery.
The complication rate and mortality rate of traditional emergency surgery for acute obstructive colorectal cancer are very high. Self-expanding metal stent (SEMS) as a bridge to surgery can rapidly decompress the intestinal tract and radical surgery can be performed after the patients’ general condition improve. This technology has been widely developed, but its safety is still controversial, mainly related to the risk of SEMS implantation and its impact on the long-term survival of patients. This article will introduce the rationale, pathophysiology, short-term safety and long-term oncology safety of SEMS implantation, in order to provide basis for clinicians to choose treatment methods.