老年人大肠癌患者内镜与临床分析

目的：探讨老年大肠癌患者的特点。方法：分析120例老年大肠癌的结肠镜检查结果、临床表现及手术治疗情况。结果：（1）老年大肠癌患者以黏液血便为主，占85％。（2）左半结肠多见，以直肠癌检出率最高；（3）直肠癌肛诊阳性率为86％，结肠癌诊断大肠癌的准确率为99％。（4）BorrmannⅠ、Ⅱ、Ⅲ型大肠癌手术根治率分别为83％，82％及53％。结论：老年患者大肠癌发生率较高，以左半结肠多见，病程长，分化好。结肠镜检查可判断大肠癌的部位、范围和程度，但只能为选择手术方式提供参考。     

老年人大肠癌特点分析

1990年以来,我院收治大肠癌313例,其中老年患者146例,所占比例较大,治疗与手术有其特殊性,现报告分析如下.     

老年人大肠癌的回顾与分析

人口老龄化是诸多国家日趋而临的问题之一.随着人类平均寿命的不断提高,老年性疾病的治疗日益受到重视.本文就我院近年收治的大肠癌患者的情况进行总结并就此做一分析.     

从86例老年人大肠癌的临床特点谈老年人大肠癌的早期诊断

目的：提高老年人大肠癌的早诊率，降低误诊率，采取及时合理的治疗，延长患者寿命。方法：对８６例老年人大肠癌的临床特点进行详细回顾性分析。结果：老年人大肠癌有其独特的临床特点。结论：彻底了解老年人大肠癌临床特点，有助于提高老年人大肠癌的早诊率，降低误诊率。     

老年人大肠癌60例外科治疗分析

目的 探讨老年人大肠癌的外科治疗方法。方法 回顾性分析1994～2003年间70岁以上老年人大肠癌的外科治疗资料。结果 老年人大肠癌入院前误诊率高（33．3％）,并存病多（85％）,肿瘤切除率83．3％．其中根治性切除58．3％,手术后出现并发症50％,手术死亡1例死于急性呼吸循环衰竭。结论 手术治疗加术后综合性治疗是老年人大肠癌的最佳治疗方法,但早期诊断,早期治疗,合理处理并存病,有效的肠道准备,适当的麻醉和手术方式,积极的预防和治疗并发症是提高手术疗效的关键。     

提高大肠癌早期诊断的水平

大肠癌是常见的恶性肿瘤 ,由于大肠癌的发病可能和高脂肪 ,低纤维素饮食有关 ,所以发达国家的发病率较高 ,我国的发病率近年来也有所上升。和任何恶性肿瘤一样 ,早期发现 ,早期治疗是提高大肠癌远期生存率的唯一途径 ,如按 Dukes分期 ,5年生存率 ,A期可达 90± % ,B期降为 75± % ,C期低于 5 0 % ,D期不及 1 0 % ,可见早期诊治的重要性。　　所谓早期一般指 Dukes A期。即 TNM分期的T1,2 N0 M0 ,T1是肿瘤仅侵及黏膜下层 ,T2 指肿瘤侵入固有肌层 ,如穿过肌层至浆膜下层则属于 B期。由于像 T1这样的早期癌 ,仍然有 1 0 %的局部淋巴结转…     

多原发大肠癌16例临床分析

目 的 探讨多原发大肠癌的诊断、治疗及预后。方法 对16例多原发大肠癌进行回顾性分析。结果 16例多原发大肠癌病人中同时癌10例,异时癌6例。术前均经纤维结肠镜检查及病理学确诊。全部病例均行手术治疗,手术切除率100％,并发症发生率12.5％。术后辅助化疗10例,放疗1例,复发率6.25％,转移率6.25％。5年生存率为70％。结论术前纤维结肠镜检查是发现同时性多原发大肠癌的重要手段。手术切除是多原发大肠癌最好的治疗方法。应根据病人及肿瘤具体情况,选择相应术式。及早诊治则预后较好。对随诊病人强调应用纤维结肠镜检查。     

老年大肠癌104例临床分析

目的探讨老年大肠癌患者围手术期处理及临床营养支持的效果。方法对104例60岁以上老年大肠癌患者行手术治疗,对患者的临床资料进行回顾性分析。结果 104例中,78例(75.00%)患有高血压、糖尿病、心脏病等老年人常见病。术后发生并发症共20例,死亡3例。手术前有并存病者,术后并发症的发生率明显高于手术前无并存病者。结论老年人大肠癌由于早期症状隐匿而拖延了病程,确诊时多在Dukes C、D期。老年大肠癌患者常患有高血压、心脏病、糖尿病等疾病。但老年人组织结构退化,肿瘤相对生长迟缓,在患者全身情况许可,有效控制各种并存病,加强围手术期的处理,可提高手术的安全性,减少并发症的发生。     

老年人大肠癌临床特点及预后

老年人大肠癌与青壮年相比有其特殊性,且日益受到重视,老年人大肠癌占大肠肛门癌的10%~20%[1],从临床角度去探索和归纳这些特点,对本病防治具有重要意义。我们总结了1994年7月~2004年7月收治的大肠癌中60岁以上病人130例的治疗结果,着重探讨老年人大肠癌的特点和影响生存的因素,作为今后提高疗效的参考。1资料与方法1.1一般资料:本组130例,男82例,女48例,最高年龄82岁,平均年龄65.3岁。其中剖腹探查行单纯造瘘17例,手术切除109例,手术切除率86.9%。1.2治疗方法;非手术治疗4例,手术治疗126例,其中运用直肠吻合器切除吻合手术48例,腹会阴联合…     

大肠癌的靶向治疗

大肠癌是常见的恶性肿瘤之一,发病率及死亡率亦逐年上升,严重威胁人们的生命。目前对大肠癌的治疗仍是以手术为主、辅以局部或全身放疗及化疗的综合治疗。早期大肠癌手术治疗效果明确,但有20～25%左右的患者在首诊时已有其它器官的转移给治疗带来了困难。而靶向治疗作为一种新的治疗手段,为晚期大肠癌的治疗开辟了新途径。     

老年人大肠癌致急性肠梗阻的外科处理

大肠癌致急性肠梗阻是大肠癌晚期临床表现之一,亦是老年人肠梗阻最常见原因。老年人大肠癌患者脏器代偿功能和机体免疫功能均下降,且多有全身其他严重疾病或肠梗阻本身引起的全身性严重病理生理变化,在临床处理中比较棘手。外科处理选择是否正确可直接影响预后。我院1980～2000年共收治老年人大肠癌致急性肠梗阻病例42例,现就     

Endoscopy of the small intestine

For the patient and the clinician, it is well that small-bowel diseases are unusual, as our ability to access this area remains limited. Frequently, all of the diagnostic and therapeutic modalities of radiology, endoscopy, and surgery are required for successful resolution of a given problem. Because management of bleeding from a small-bowel source usually will involve the surgeon at some point, it is mandatory that the best "road map" be obtained prior to exploration. If a small-bowel source is suspected after a negative endoscopic evaluation of the esophagus, stomach, duodenum, and colon, then the clinician must decide which radiographic and endoscopic examination is most appropriate. If bleeding is slow or intermittent, push-type enteroscopy to evaluate the proximal jejunum will have an expected diagnostic discovery rate of about 30 per cent. A stiffening over-tube or internal cable should result in deeper passage of the instrument and a potentially greater yield. Retrograde ileoscopy should be a part of every colonoscopy done for occult bleeding. If endoscopy does not identify a bleeding source, then a detailed barium study of the small bowel using an enteroclysis double-contrast technique will discover more pathology than a standard small-bowel-follow-through. Because sonde-type enteroscopes are not readily available, the clinician must decide at this point whether to refer the patient to an enteroscopist or consider surgery and intraoperative endoscopy. If a bleeding source has been found, then intraoperative endoscopy can localize lesions for specific resection. If the pathology remains obscure, intraoperative endoscopy will have a discovery rate of about 70 per cent. For more active hemorrhage, a bleeding scan with 99mTc-labeled red blood cells can confirm that blood loss is continuing and also will guide the angiographer toward a more directed study, thus decreasing the contrast material load for the patient. If a bleeding source can be identified angiographically, a short course of vasopressin infusion to convert the need for surgical intervention to a more elective situation would be beneficial to the patient. Intraoperative endoscopy under urgent conditions is more difficult, because luminal blood must be lavaged or cleared for a proper examination. Many times, however, intraoperative endoscopy can "surround" a segment of intestine by identifying areas that are clearly normal.     

具有家族背景大肠癌34例临床分析

目的 了解具有家族背景大肠癌的临床特点，为大肠癌的筛检提供线索。方法 对４１６例大肠癌进行家系调查，对其中３４例具有家族背景大肠癌的家系、临床资料及病理组织学表现进行分析。结果 具有家族背景大肠癌占同期大肠癌的８．２％。与无家族史的散发性大肠癌相比，其发病年龄显著提前，右半大肠癌、大肠外癌及低分化癌的发生率均显著增高（Ｐ〈０．０５）；多原发癌的发生及转移复发与家族史无明显关系（Ｐ〉０．０５）。结论     

The early diagnosis of carcinoma of the large intestine

The earliest ascertainable clues and symptoms of carcinoma of the colon and rectum have been considered, and factors aiding in an early and positive diagnosis have been reiterated.The most common initial symptoms of malignant growths of the right side of the colon are pain, palpable tumor and indefinite dyspepsia. Lesions in the transverse colon manifest themselves first by pain, obstructive attacks and developing or increasing constipation. Carcinoma of the descending colon and sigmoid is manifested first by increasing constipation or obstruction, pain, rectal bleeding and diarrhea. Carcinoma of the rectosigmoid and rectum is suggested by a change in bowel habit, either constipation or diarrhea, and rectal bleeding. The diagnosis of malignant lesions of the colon is rendered certain by roentgenographic examination. The presence of lesions in the sigmoid or below it may be proved by proctoscopic and digital examination of the rectum.