高龄结肠癌并发穿孔19例临床分析

目的探讨高龄结肠癌患者并发穿孔的临床特点、手术方式的选择以及围手术期的处理。方法回顾性分析2000年1月至2010年7月我科收治的19例高龄结肠癌患者并发穿孔的临床资料。结果 3例行肿瘤切除Ⅰ期吻合术,其中1例发生吻合口漏;12例患者行Hartman术,围手术期1例死于呼吸衰竭;4例行单纯双腔造瘘术,围手术期1例死于脓毒血症。围手术期的死亡率为10.53%。结论结肠癌并发穿孔后早期手术是治疗本病的关键,呼吸衰竭和脓毒血症是常见的死亡原因,手术方式应根据患者的具体情况选择个体化的手术治疗方案,Hartman术作为安全有效的手术方式,值得推荐。

A clinical analysis of 19 elderly cases of colon cancer complicated with perforation

Objective To investigate the clinical features,the choice of surgical approach and perioperative treatment of elderly patients with colon cancer and perforation. Methods To retrospectively analyze clinical data of 19 elderly patients suffered from colon cancer complicated with perforation from January 2000 to July 2010.Results 3 cases were treated by tumor excision and I stage anastomosis,and anastomosis leakage occurred in 1 case; 12 cases were treated by Hartmann surgery,and respiratory failure occurred in 1 case; 4 cases were treated by simple fistulization,pyemia occurred in1 case.Conclusion Prophase surgery is critical to elderly cases of colon cancer complicated with perforation. Respiratory failure and pyemia are the main reason led to death. Hartmann surgery is safe and effective to these patients.