大腸癌イレウスの臨床病理学的検討とその治療，特に緊急手術の適応について

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  • The Studies of Clinicopathological Features and Treatments of Obstructive Colorectal Cancer.

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Clinicopathological features of colorectal cancer patients with obstruction were compared with those of patients without obstruction, and surgical treatments and indications for an emergency operation for obstructive colorectal cancer were studied. The study group consists of 252 patients with carcinoma of the large bolwel, 31 of them (12.3%) with obstruction, between 1976 and 1994. In the group with obstruction there was a significantly higher incidence of bowel obstruction in males. Macroscopically, the incidence of type 3 cancer of the circumferential type was higher than in the non-obstructive cases. Histologically, the incidence of a lesion showing depth of invasion of the sub-serosa (ss) or deeper invasion of a lesion of n (+), ly (+) and v (+) was higher than in non-obstructive cases. Depending on the advance of the lesion, a significantly higher incidence of hepatic metastsis, peritoneal dissemination and stage IIIa or more severe cancer, was found in the obstructive group. The rates of resection and curative resection in the obstructive group were lower than those of the non-obstructive group. However, those rates were higher in the primary resection cases with obstruction. Our hospital's first treatment is primary curative resection with anastomosis by tube drainage. However, some patients with left-side colorectal cancer required emergency surgery because of severe obstruction. The emergency surgery in our hospital follows these criteria: 1) after 7 days of ileus complication; 2) accompanying strong pain or pressure discomfort; 3) non-effective tubal drainage up to 4 days. In addition, high-risk patients have to have a staged operation with colostomy. In low-risk patients, a one-stage operation with anastomosis is necessary.

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