Training material VIII
Treatment points of radical resection of colon cancer
结肠癌一旦明确诊断后应尽早地施行手术治疗，但手术治疗是治疗原则中的一部分，还应考虑综合性治疗。横结肠癌应采取横结肠切除术，切除范围应包括肝曲和脾曲的整个横结肠，还应包括胃结肠韧带的淋巴结组，然后行升结肠和降结肠端端吻合术，倘若两端张力大而不能吻合，可切除升结肠、盲肠和回肠末段，然后作回肠与降结肠吻合术。
结肠癌虽已有肝转移，但如原发癌及系膜淋巴结转移癌尚可完全切除，而肝内触及的转移灶为单个，且其所在部位做局部切除困难不大时，也可以切除原发癌的同时，将肝内转移灶切除，部分病人可因此而获得较长时间的缓解，少数病人尚可有5年或更长的生存期。
Surgical treatment should be performed as soon as possible after a definite diagnosis of colon cancer, but surgical treatment is part of the principle of treatment and comprehensive treatment should also be considered. Transverse colon cancer shall be subjected to transverse colon resection, which shall cover the whole transverse colon of liver curve and spleen curve as well as the lymph node group of gastric-colon ligament. Then end-to-end anastomosis of ascending colon and descending colon shall be performed. In case the tension at both ends is large enough for anastomosis, the ascending colon, cecum and terminal ileum may be excised, followed by anastomosis of ileum with descending colon.
Although colon cancer has liver metastasis, for example, primary cancer and mesangial lymph node metastasis cancer can still be completely excised, and the metastatic foci touched in the liver are single, and when it is not difficult to locally resect the site, the primary cancer can also be excised and the intrahepatic metastatic foci can be excised at the same time, which can result in long-term remission for some patients, and survival time of 5 years or more for a few patients.
Principles of operation technique in radical resection of colon cancer;
- prevent in the process of surgery as much as possible cancer cells hematogenous spread and local planting.
- avoid extrusion during the operation of cancer with care.
- before freeing the cancer, block pathways to prevent the cancer cells planting in the intestinal cavity and the blood metastasis.
Intestinal preparation before surgery:
Preparation before colectomy is an important measure to reduce intraoperative contamination, prevent postoperative infection of the abdominal cavity and incision, and ensure good healing of the anastomosis. The purpose of intestinal preparation is to empty the feces in the colon without flatulence, and the number of intestinal bacteria will be reduced.
Intestinal preparation method:
The colon is cleaned during the operation by regulating diet, taking laxative and cleaning the intestinal tract.
- Three days before surgery, only liquid food is taken, at the same time take 30g oral senna, three times a day, giving 1500-2000 ml of fluid infusion every day.
- Three days before surgery, patients are orally administrated with 0.5 metronidazole four times per day and 0.2 norfloxacin four times per day.
- One night before operation, perform a clean enema (with soap and water), do it again the next morning with water.
Surgical procedures:
- The bowel is blocked with a cloth tape, including the marginal vessels, at a distance of 10cm from each side of the tumor margin.
- The arteriole and vein ready to be cut are exposed at the root of mesangium, which was then ligated and cut off respectively. From then on, the mesangium is gradually cut off to the intestinal part which is to be cut off too.
- Free the bowel segment with cancer, and remove it.
- After the intestinal anastomosis, rinse the operation area with sterile distilled water, in order to be able to destroy the dropped-off cancer cells.
Postoperative complications:
- Due to the long course of disease and incomplete obstruction symptoms, intestinal preparation may not meet the requirements; once the abdominal cavity during the operation is polluted, it can cause abdominal infection.
- Because of the intestinal wall edema, and different degrees of bowel expansion, with transverse colon resection, the colon end-to-end anastomosis is easy to incur compound mouth fistula or anastomosis stenosis caused by anastomosis tension.
- Transverse colectomy leads to abdominal itching, easy to cause abdominal bowel adhesion.
- Transverse colectomy is more difficult than that for right or left hemicolectomy, and it is prone to bleeding or accidental injury of other organs, such as ureter, pancreas and inferior vena cava.
- abdominal incision is fairly big, prone to incision infection.
Postoperative treatment:
- pay attention to blood pressure, pulse, breathing within 48 hours after surgery
- pay attention to intra-abdominal hemorrhage and wound bleeding
- remove the catheter after 48 hours of postoperative retention
- pay attention to supplement liquid and electrolyte every day
- doses of broad-spectrum antibiotics
This article was originally published in Proceedings of Wuhu Annual Surgical Conference,1996；28-30 Changhang Hospital, Li Mingjie
from 外科截瘫14例手术分析
