老年人结肠癌并急性肠梗阻86例外科处理分析

目的探讨老年人结肠癌并发急性肠梗阻的特点、诊断、外科处理方法与预后。方法回顾性分析我院2000年1月—2009年8月86例年龄〉60岁的老年患者手术治疗的结肠癌并发急性肠梗阻病人的临床资料,其中一期切除吻合58例（右半结肠一期切除吻合39例,左半结肠一期切除吻合19例）,分期手术19例（右半结肠4例,左半结肠15例）,行Hartmann手术。肿瘤无法切除行单纯结肠造瘘和捷径手术9例。结果术后出现并发症8例,发生率为9.3%,其中切口感染3例,腹腔感染2例,肺部感染2例,感染性休克1例,1例死亡,病死率1.2%,85例痊愈出院。结论老年人结肠癌致肠梗阻的外科治疗要根据老年病人的具体情况选择合理的术式,准确的早期诊断,恰当的围术期处理,正确的手术方式的选择,是提高其预后的关键。

Surgical treatment analysis of 86 elderly patients with colonic cancer complicated with acute intestinal obstruction

Objective To discuss the characterization,diagnosis,surgical treatment and prognosis of elderly colonic cancer complicated with acute intestinal obstruction.Methods Analysis was conducted on 86 elderly patients（older than 60 years） with colonic cancer complicated with acute intestinal obstruction,who were hospitalized in our hospital due to from January 2000 to August 2009.All the patients underwent surgical treatment,including resection and anastomosis at stage Ⅰ in 58 cases（right colon resection and anastomosis in 39 cases,left colon resection and anastomosis in 19 cases）,Hartmann surgery at stage Ⅱ in 19 cases（right colon in 4 cases,left colon in 15 cases） and simple colostomy and shortcuts surgery in 9 cases（not appropriate for removal）.Results Eight（9.3%） patients suffered from postoperative complication,including wound infection in 3 cases,intraabdominal infection in 2 cases,pulmonary infection in 2 cases,and septic shock in 1 case.One patient died with a fatality rate of 1.2%,and the other 85 patients were discharged after healing up.Conclusion Reasonable surgical approaches to colonic cancer complicated with obstruction should be chosen for elderly patients.Accurate early diagnosis,as well as appropriate perioperative management,is the key to the improvement in prognosis.