ABSTRACT
Objective To investigate the clinical characteristics, diagnosis and treatment of acute intestinal perforation in the patients with colorectal carcinoma. Methods The clinical data of 38 colorectal carcinomas complicated with acute intestinal perforation treated in our hospital during 19 years were analyzed retrospectively. Results Acute intestinal perforation was common in old patients with colorectal carcinoma (mean age 62 years).The primary lesions were mostly located in left-side colon and superior rectum(27/38,71.1%). The perforation in the proximal colon of tumor and cecum accounted for 81.6%(31/38), and in tumor site accounted for 18.4%(7/38). The correct rate of preoperative diagnosis was only 15.8%(6/38). The postoperative complications were common and severe. The perioperative mortality was 42.1%(16/38). All the causes of death were multiple organ function deficiency. There were close relations between perioperative mortality and operation time. The postoperative recurrent rate was 41.2%(7/17). Five-year survival rate was 23.5%(4/17). Conclusion Early diagnosis, early operation and active prevention and treatment of multiple organ function deficiency were key to decrease the mortality of the colorectal carcinoma patients with acute intestinal perforation.
ABSTRACT
Objective To study the diagnosis and treatment of blunt pancreatic injury (BPI). Methods A retrospective analysis was made on the clinical data of 58 cases of BPI admitted and treated in our hospital during 23 years. Results The positive diagnosis rate was 51.1%(23/45) for single BUS examination ,but 70.0%(21/30) for two and more BUS examimations. The positive diagnosis rate was 65.0%(26/40) for single CT scanning, but 91.3%(21/23) for two and more CT scannings. Twenty-five cases(25/37,67.6%) with BPI were determined preoperatively, and 12 cases(12/37,32.4%)during (operation).Thirty-seven cases underwent operatiom, included grade I in 10cases、grade II 13cases、grade III 9cases、 grade IV 4cases and gradeV 1case. Twenty-one cases received nonoperative treatment, included 11 grade in I,7 grade II and 3 grade III. In the entire group, 6 cases died(10.4%).The mortality in the operation group was 16.2%(6/37).There were no deaths in the nonoperative group. The main cause of death was multiorgan failure(5/6,83.3%). There were 11(19.0%)cases of pancreatic pseudocyst after treatment in the entire group, included 3(3/37,8.1%) in operation group and 8(8/21,38.1%) in nonoperation group. Conclusions The diagnosis of BPI should combine the clinical findings with repeated BUS and CT scanning. Nonoperative treatment is a good choice for BPI without main pancreatic duct injury. Operative treatment is suitable for serious BPI and those with other intra-abdominal organ jnjury.