Clinical Characteristics Analysis Of Large Intestine Perforation Caused By Colorectal Cancer

Objective The large intestine perforation caused by colorectal cancer is a rare surgical acute abdomen.Because of its insidious onset,the preoperative diagnosis rate is low,the disease progresses rapidly,and the prognosis is poor.This study aimed to analyze the preoperative diagnosis,intraoperative condition and clinical features of postoperative treatment of colorectal perforation caused by colorectal cancer,in order to improve clinical vigilance,for the early diagnosis of clinical,reasonable choice of surgery,reduction Post-complications,etc.provide possible assistance.Methods Retrospectively analyze a total of 33 cases of large intestine perforation caused by colorectal cancer admitted to the Department of Acute Abdominal Surgery of the Second Affiliated Hospital of Da Lian Medical University from January to February2018,2014 were collected.The above cases were perforated with large intestine and tumor.The positional relationship was divided into the proximal perforation group(15cases)and the in situ perforation group(18 cases).The basic clinical data,preoperative auxiliary examination indexes,and intraoperative conditions were compared and analyzed.The postoperative complications were divided into hemofiltration treatment group and non-hemofiltration treatment group,and the postoperative complications of the two groups were compared.The measurement data were analyzed by independent sample t test,and the count data were analyzed byc2 test.The difference of P<0.05 was statistically significant.Results 1.In the comparison of basic clinical data,the general data,clinical history of defecation habit change history and septic shock,preoperative diagnosis of gastrointestinal perforation,comorbidities,ASA classification,AJCC staging were not statistically significant,The history of constipation(p=0.048)and abdominal distension(p=0.001)in the performance,the proximal perforation group was significantly higher than the in situ perforation group,which was statistically significant.Of all cases,21(64%)had a history of changes in bowel habits,11(33%)had septic shock,33(100%)had peritonitis,and 10(30%)had preoperative diagnosis of gastrointestinal perforation.2.In the comparison of preoperative auxiliary examination indexes,WBC(>9.5×10~9/L)and CRP(>50mg/L)in laboratory examination were not statistically significant,and blood lactate level(>1.6mmol/L)at the proximal perforation group was significantly higher than at the in situ perforation group,p=0.003,which was statistically significant.Signs of intestinal dilatation(p=0.032)and signs of peritoneal effusion(p=0.026)in preoperative abdominal CT were statistically significant.A total of 7 cases(22%)of underarm free gas in abdominal X-ray examination,10 cases(30%)of abdominal free gas in abdominal CT examination,3 cases(9%)of intestinal wall discontinuity,local intestinal wall thickening 26 cases(79%),18 cases(55%)of local intestinal wall gas accumulation.3.In the intraoperative comparison,there was no statistically significant difference in the choice of surgical methods between the two groups,but overall,32 patients(97%)underwent open surgery and 1(3%)underwent laparoscopic surgery.Of the 33 patients,21(64%)had ostomy and 12(36%)had no ostomy.The comparison of R0 resection (p=0.026)between the two groups was statistically significant.In the perforation position,there were 6 cases of cecum,8 cases of ascending colon,11 cases of sigmoid colon,and 8 cases of rectum.There were 29 cases of perforation in perforation,and only 4 cases of more than 1 perforation.4.In the postoperative comparison,the hemofiltration group had fewer incision infections(p=0.024),abdominal infection(p=0.026),sepsis(p=0.049),and shorter hospitalization time(p=0.038)than the non-hemofiltration group.Three patients(9%)died after surgery.Conclusions 1.The preoperative diagnosis rate of large intestine perforation caused by colorectal cancer is low,and it should be vigilant in clinical practice.For elderly patients with sudden abdominal pain and constipation history and changes in bowel habits,we should think of the possibility of this disease.Bloating and elevated blood lactate levels suggest that the patient have serious condition.2.Abdominal CT examination is the main method of diagnosis,although the positive rate is low,but once there is a positive sign,it can be diagnosed.Direct signs include free gas in the abdominal cavity,discontinuity of the intestinal wall and contrast agent spillover.Indirect signs include intestinal dilatation,local intestinal wall thickening,local intestinal wall accumulation,and peritoneal effusion.The combination of signs and indirect signs can increase the diagnostic rate.3.In the choice of surgical methods,most patients underwent open surgery and ostomy.For patients with milder abdominal cavity and better general condition,intraoperative colonic lavage can be combined with one-stage anastomosis.4.Hemofiltration after surgery can improve the patient’s efficacy.