1.5 小结
综上所述，右半结肠癌相关急腹症不同于良性疾病导致的急腹症，其病情更加复杂，外科治疗是右半结肠癌合并梗阻和穿孔的主要治疗手段，选择正确的手术时机和合理个体化手术方式、重视围手术期处理，可达到满意的疗效。我们要从多角度思考和制订治疗策略，考量因素包括患者身体各系统器官功能和营养状况评估，并发急腹症的类型及严重程度，右半结肠肿瘤本身特性、分期和可切除性等。治疗过程需抓住主要矛盾，以抢救生命为第一原则，处理并发症的同时，争取原发肿瘤一期切除。所以优秀的急诊外科医生需要具备MDT 的全局理念和丰富的临床经验，既能主导复杂的MDT 讨论或灵活的学科会诊，还要能做到平衡利弊、当机决断。 此外，治疗难度和手术风险较大，术前应详细向患者家属交代治疗风险，并获得理解。熟练掌握右半结肠癌所致的常见急腹症的诊断要点和治疗策略，对于结直肠外科医师、普外科医师、急诊外科医师均具有重要意义。
（王颢）
参考文献
[1]ASKARI A,MALIETZIS G,NACHIAPPAN S,et al.Defining characteristics of patients with colorectal cancer requiring emergency surgery[J].Int J Colorectal Dis,2015,30(10):1329-1336.
[2]PISANO M,ZORCOLO L,MERLI C,et al.2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation[J].World J Emerg Surg,2018,13:36.
[3]MEGE D,MANCEAU G,BEYER-BERJOT L,et al.Surgical management of obstructive right-sided colon cancer at a national level results of a multicenter study of the French Surgical Association in 776 patients[J].Eur J Surg Oncol,2018,44(10):1522-1531.
[4]TIWARY S K,SINGH M K,KHANNA R,et al.Colonic carcinoma with multiple small bowel perforations mimicking intestinal obstruction[J].World J Surg Oncol,2006,4:63.
[5]KAHI C J,REX D K.Bowel obstruction and pseudo-obstruction[J].Gastroenterol Clin North Am,2003,32(4):1229-1247.
[6]Buvanendran A,Buvanendran A,Hurley R W,et al.Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain Management From the American Society of Regional Anesthesia and Pain Medicine,the American Academy of Pain Medicine,and the American Society of Anesthesiologists[J].Regional Anesthesia pain Medicine,2018,43(5):456-466.
[7]MEDLEJ K.Calculated decisions: sequential organ failure assessment (SOFA) score[J].Emerg Med Pret,2018,20(Suppl10):CD1-CD2.
[8]中国医师协会外科医师分会，中国医师协会外科医师分会肿瘤外科医师委员会，中国医师协会外科医师分会多学科综合治疗专业委员会.恶性肿瘤相关急腹症多学科管理中国专家共识[J].中华胃肠外科杂志，2020，23（5）：17.(https://www.daowen.com)
[9]JIM
NEZ FUERTES M,COSTA NAVARRO D.Resection and primary anastomosis without diverting ileostomy for left colon emergencies: is it a safe procedure?[J].World journal of surgery,2012,36(5):1148-1153.
[10]FAUCHERON J L,PAQUETTE B,TRILLING B,et al.Emergency surgery for obstructing colonic cancer: a comparison between right-sided and left-sided lesions[J].European journal of trauma and emergency surgery : official publication of the European Trauma Society,2018,44(1):71-77.
[11]OTSUKA K,KIMURA T,HAKOZAKI M,et al.Comparative benefits of laparoscopic surgery for colorectal cancer in octogenarians: a case-matched comparison of short- and long-term outcomes with middle-aged patients[J].Surg Today,2017,47(5):587-594.
[12]康泰，韩新巍，任建庄，等.DSA下支架置入对于右半结肠癌性梗阻的疗效与价值[J].临床放射学杂志，2017，36（3）：4.
[13]ANWAR M A,D'SOUZA F,COULTER R,et al.Outcome of acutely perforated colorectal cancers: experience of a single district general hospital[J].Surg Oncol,2006,15(2):91-96.
[14]CAHALANE M J.Gastrointestinal perforation[J].UpToDate,2020.
[15]CHEN S C,YEN Z S,WANG H P,et al.Ultrasonography is superior to plain radiography in the diagnosis of pneumoperitoneum[J].Br J Surg,2002,89(3):351-354.
[16]STRATE L.Summary of acute lower gastrointestinal bleeding in adults[J].UpToDate,2020.
[17]程洁敏，王建华.血管造影和介入治疗在消化道出血诊治中的应用[J].中国实用外科杂志，2010，30（6）：5.
[18]盛卫忠，姚璐，董天庚，等.急性下消化道出血的临床外科诊治分析[J].中国临床医学，2019，26（6）：4.