高龄大肠癌手术治疗体会

目的探讨高龄大肠癌围手术期处理的有关问题,提高外科手术治疗效果。方法回顾性分析1990年1月～2004年6月90例70岁以上的大肠癌病人的外科治疗资料。结果多数大肠癌病人术前并存疾病多(75.6%),肿瘤切除率为85.6%,根治性切除率为66.7%,术后并发症发生率为47.8%,围手术期死亡6例,病死率为6.7%。结论外科手术切除是多数大肠癌首选治疗方法,术前对并存疾病的合理有效治疗以及围手术期的严格监测处理是减少术后并发症、降低病死率、提高治疗效果的关键。     

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。     

以急腹症就诊的大肠癌外科诊治分析（附29例报告）

目的 总结以急腹症为首发症状的大肠癌的外科诊治体会.方法 回顾性分析以急腹症就诊的29例大肠癌患者的临床资料.结果 经纠正水电解质、酸碱失衡,胃肠减压,抗感染等及手术治疗,无手术死亡病例,术后发生并发症15例,2例于术后72h内死亡;随访1年生存率为88.9%,3年生存率为29.6%,5年生存率11.1%.结论 结肠癌并急腹症的早期诊断、合理的术中及术后处理是提高患者术后生存率和减少术后并发症的重要环节.     

160例70岁以上高龄普胸手术患者围术期处理

目的总结高龄普胸手术患者围术期处理体会.方法对我院自1995年5月至2003年1月160例70岁以上高龄患者施行普胸手术的围术期处理进行回顾分析.结果术后出现或加重的循环系统并发症42例(26.3%),呼吸系统并发症14例(8.8%).围术期死亡1例,手术死亡率为0.63%.随访123例,随访率77.4%,术后1年、3年和5年生存率分别为87.0%、65.0%和30.1%.结论对70岁以上老年人普胸手术的围术期处理主要为防止及治疗全身各系统的并发症,其次应注意疾病本身的并发症.只要病例选择恰当,70岁以上高龄患者施行普胸手术围术期安全.     

70岁以上肺癌病人的外科治疗

手术治疗70岁以上的原发性支气管肺癌26例,其中Ⅰ期2例,Ⅱ期6例,Ⅲa期16例,Ⅲb期2例;鳞癌13例,腺癌8例,未分化癌4例,腺鳞癌1例。手术切除24例,探查2例。术后有并发症者7例,5年生存率30.8％,无手术死亡。作者等认为,对70岁以上的肺癌病人应积极行外科治疗,且关键是加强围术期管理。     

高血糖大肠癌病人的围手术期处理

目的：探讨高血糖大肠癌病人围手术期的处理方法。方法：对1997～2002年外科治疗的70例高血糖大肠癌(空腹血糖大于6．1mmol／L)病人作回顾性分析。结果：70例病人均作择期手术，术后并发症发生率：吻合口瘘占8．8％(3／34)。切口感染20．6％，肺部感染、泌尿系感染均为2．9％。无酮症酸中毒发生，无手术死亡。术后平均住院19d。结论：高血糖大肠癌病人的外科治疗必须作好围手术期处理。只要严格控制血糖、选择合理的术式和时机就完全可以达到理想的外科治疗效果。     

3200例食管癌病人外科治疗体会

目的总结食管癌病人围术期处理经验,提高此类病人的外科治疗效果。方法1996~2016我科手术治疗的食管癌病人3200例,按照年份分成2组:1996年1月~2006年1月组(A组)900例,2006年2月~2016年12月组(B组)2300例。比较两组病人术后吻合口瘘、吻合口狭窄、乳糜胸发生率,围术期死亡率以及术后5年生存率。结果 A组病人术后吻合口瘘50例,吻合口狭窄60例,乳糜胸70例,围术期死亡26例,术后5年生存率为28.0%。B组病人术后吻合口瘘52例,吻合口狭窄72例,乳糜胸88例,围术期死亡30例,术后5年生存率为35%。结论个体化、规范化的外科治疗,可降低食管癌病人围术期并发症发生率,提高5年生存率。     

老年人结直肠腺瘤癌变的特点及外科治疗

目的探讨老年人结直肠腺瘤癌变的临床特点及合理的外科治疗。方法回顾分析1990～2004年收治的76例70岁以上的结直肠腺瘤癌变患者的诊断和治疗情况。结果本组平均发病年龄77.5岁,男女比例为2.8∶1,平均病程2.6年。DukesA期占22.4%,B期占63.2%,C期占14.5%。术前并存疾病的发生率为68.4%,并存2种以上疾病者为40.8%。主要采取根治性切除及肠段切除术,分别占46.1%和43.4%。术后并发症发生率为32.9%,术后死亡率为2.6%,手术切除率100%。5年以上生存率为47.4%。结论对老年人结直肠腺瘤癌变患者,选择适当的手术方式,加强术前并存疾病的处理和术后监测,可以提高手术耐受性和治愈率,降低手术风险和并发症发生率。     

高龄大肠癌术后并发症防治体会（附86例报告）

目的 总结高龄大肠癌患者术后并发症防治的经验。方法回顾性分析手术治疗的86例70岁以上老年人大肠癌病例资料。结果所有患者均行手术治疗（13例因并发结直肠梗阻而行急症手术）,其中64例（73．3％）属根治性切除（D3）,13例肿瘤姑息性切除,6例仅永久性结肠造口术．3例剖腹探查加肿瘤种植结节或转移淋巴结活检术。总切除率为89．5％。无手术死亡病例。15例发生并发症共21例次,占17．4％,其中肺部感染7例、切口感染7例、切Ⅵ裂开3例、尿潴留1例,心力衰竭2例、脑血管意外1例等,无吻合口瘘。本组获得随访77例,其中1年生存率是85．7％（66／77）,3年生存率70％（54／77）5年生存率41．5％（32／77）。结论做好高龄大肠癌的术前准备（包括内科伴发病的处理）,正确掌握不同术式的适应证和手术操作以及术后处理,可有效提高手术成功率,降低死亡率和术后并发症的发生。     

高龄大肠癌病人的围手术期处理及营养支持

目的：探讨高龄大肠癌病人的围手术期处理及营养支持。方法；回顾分析了1990～2003年间70岁以上大肠癌126例资料。结果：根治切除89例（70.6％），姑息切除12例，Hartmann手术15例，单纯造口6例，短路手术4例。无手术死亡。术后并发症73例（57.9％），死亡8例（6.3％），术后因合并症放弃治疗2例（1.6％）。结论：重视高龄大肠癌病人的围手术期处理、营养支持及术后加强监护治疗（ICU），对提高手术切除率（耐受性）、减少手术并发症，改善预后有积极作用。     

The impact of advanced age on hepatic resection of colorectal liver metastases

BACKGROUND: The aim of this study was to evaluate the impact of patient age on surgical therapy for colorectal liver metastases. STUDY DESIGN: Between 1992 and 2004, 212 consecutive patients underwent potentially curative hepatic resection. Sixty-two patients were 70 years or older at the time of resection (older group) and 150 patients were less than 70 years at the time of resection (younger group). RESULTS: A proportion of older patients had a history of severe cardiopulmonary disease (32.3%) and respiratory insufficiency (6.5%). Intraoperative variables, such as resected liver volume, operation time, estimated blood loss, and blood transfusion, were not notably different between older and younger patients. Postoperative complications after resection occurred in 19.7% of older patients and at a similar rate (23.3%) in the younger group. Resection mortality was 0% in older patients and 0.49% in younger patients. The 5-year survival rates of older and younger patients were 34.1% and 53.1%, respectively. Compared with younger patients, the overall survival rate of older patients was markedly lower (p<0.01). CONCLUSIONS: Advanced chronologic age cannot be regarded as a medical contraindication for hepatic resection of colorectal liver metastases in patients who are more than 70 years of age.     

老年人结直肠癌的外科治疗（附98例分析）

目的探讨老年结直肠癌患者的外科治疗情况。方法回顾性分析98例经外科治疗的60岁以上结直肠癌患者的临床资料。结果老年结直肠癌患者入院前误诊率为52%,并存病为57.2%,手术切除率为92%,术后并发症发生率为32.6%,围手术期死亡率3%。结论手术切除是老年结直肠癌患者最好治疗方法,但早期诊断,合理处理并存病,选择适当的手术方式,积极预防和治疗并发症是外科手术治疗成功的关键。     

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目的探讨合并心血管病高龄结直肠癌病人的围手术期处理。方法根据ACC/AHA制定的非心脏手术围手术期心血管评估指南标准,将2004年1月至2006年12月间在上海交通大学医学院附属新华医院手术的306例70岁以上合并心血管病结直肠癌病人分为高危、中危和低危3级后进行围手术期干预并做回顾性分析。结果高危20例,中危70例,低危216例。术后重度血压升高22例,充血性心力衰竭10例,心绞痛3例,心肌梗死1例,各类心律失常102例。切口裂开3例,肺部感染34例,糖尿病酮症酸中毒1例,肾功能不全4例,吻合口漏6例,应激性溃疡8例。围手术期死亡4例,其中评估为高危者2例,中危者2例。结论术前合并心血管疾病增加了手术的风险,但完善术前评估、加强围手术期的处理可提高手术的安全性,降低手术死亡率和并发症发生率。     

70岁以上进展期贲门癌患者103例临床分析

目的探讨70岁以上进展期贲门癌患者的临床特点与外科治疗。方法对1991～2003年收治的103例70岁以上及小于70岁的进展期贲门癌患者的临床资料进行分析比较。结果两组患者在肿瘤病理分型、分期、手术方式方面比较,差异无统计学意义(P>0.05);临床症状和术前并存疾病比较,差异有统计学意义(P<0.01)。大于70岁组以进食梗阻感为主要症状(64%),术前并存心血管系统和肺部疾病者分别占63%、34%,有贫血和低蛋白血症者占68%。两组经腹全胃切除术分别占78%和73%(P>0.05)。术后发生肺部感染者两组差异无统计学意义(P>0.05)。两组手术死亡率分别为3%、2%(P>0.05)。结论对70岁以上进展期贲门癌患者,采用经腹全胃切除是安全的术式;术前应对患者重要脏器功能进行全面检测,术后尤应重视并发症的预防。     

Colorectal cancer surgery in patients older than 80 years of age: experience at one nonteaching hospital in Japan

The safety and efficacy of surgical treatment for colorectal cancer in patients older than 80 years of age are seldom assessed. The aim of the present study was to compare short- and long-term outcomes after surgery between younger and elderly patients at a single nonteaching hospital. In all, 342 consecutive patients who underwent surgical resection for invasive primary colorectal cancer between April 1999 and April 2007 were included in the study. Patients were divided into two groups according to their age at the time of surgery, those younger than 79 years of age (n = 283) and those older than 80 years of age (n = 59). A greater proportion of elderly patients had concurrent disease before surgery, right-sided colon cancer, and postoperative complications. Cox proportional hazards model (multivariate analysis) identified three independent risk factors for a poor outcome after surgery (excluding death by other causes): 1) the presence of preoperative symptoms; 2) noncurative resection for colorectal cancer; and 3) the presence of lymph node metastases. Age older than 80 years was not a risk factor for a poor postoperative prognosis. At our nonteaching hospital, surgical resection appears to be a safe and beneficial treatment option for elderly patients (older than 80 years of age) who have colorectal cancer.     

Cause and place of death in patients dying with colorectal cancer

OBJECTIVE: Few studies on colorectal cancer look at the one-third of patients for whom treatment fails and who need a management strategy for death. This paper has examined the mode and place of death in patients with colorectal cancer. METHOD: This study was a review of 209 deaths, analysed between January 2001 and September 2004 by retrospective review of a prospectively collected database. RESULTS: A total of 118 patients (group 1) had undergone resection of their primary colorectal cancer, 20 (group 2) had had a defunctioning stoma or bypass surgery and the remaining 71 patients (group 3) had either had no surgery, an open and close laparotomy or had a colonic stent. One hundred and fifty-six (75%) patients died of colorectal cancer with the remainder dying of other causes. The number of admissions to hospital and the number of days spent in hospital from diagnosis to death were greatest in group 1. Overall, only 34 patients (22%) dying from colorectal cancer died at home. Forty (26%) died in hospital and 70 (45%) died in a palliative care unit. CONCLUSIONS: Patients dying from colorectal cancer who undergo surgical resection of their primary tumour spend more time between diagnosis and death in hospital. They are also more likely to die in hospital than patients treated by surgical palliation or nonsurgically. Patients who are treated palliatively from the outset (group 3) are most likely to die at home. If hospital is accepted as an appropriate place for death from colorectal cancer, then greater provision for this should be made.     

高龄大肠癌合并糖尿病19例外科治疗体会

目的　探讨高龄大肠癌合并糖尿病的外科治疗措施。方法　对我院 1 993年 1月～2 0 0 1年 1 2月外科治疗的 1 9例高龄大肠癌合并糖尿病病人作回顾性的分析。结果　 1 9例均行择期手术。术后并发症发生率 :肺部感染 2 1 % ,心律失常 1 0 .5 % ,泌尿系统感染 1 5 .6 % ,切口感染 1 0 .5 %。无吻合口瘘和酮症酸中毒发生。术后平均住院时间 2 5d ,无死亡病例。结论　对高龄大肠癌合并糖尿病者只要围手术期严格控制血糖 ,选择合理术式 ,完全可以达到理想的外科治疗效果     

163例高龄结直肠癌合并糖尿病患者的围手术处理体会

目的 探讨高龄结直肠癌合并糖尿病患者的围手术处理。方法 对1994-2004年围手术处理的163例高龄（年龄大于印岁）结直肠癌合并糖尿病患者作回顾性分析。结果 163例病人均作结直肠癌择期手术,术后并发症发生率39．9％,其中切口感染19．6％（32／163）,肺部感染12．3％（20／163）,吻合口漏占3．7％（6／163）,泌尿系感染为2．5％（4／163）,高渗性昏迷1．2％（2／163）,死亡0．6％（1／163）。术后平均住院20天。结论 如能做到控制血糖、选择合理的术式和手术时机,高龄结直肠癌并糖尿病患者可顺利度过围手术期,并取得良好的手术疗效。     

COLORECTAL SURGERY IN THE ELDERLY: AN AUDIT OF SURGERY IN OCTOGENARIANS

Background : Morbidity and mortality rates are higher in elderly compared to younger patients undergoing colorectal cancer surgery. This study was undertaken to see whether this finding applied to all colorectal surgery in the elderly and if so to try to identify the determining factors. Methods : All patients undergoing colorectal surgery between 1975 and 1990 were entered into a computerized database. Patients were divided into two groups, those less than 80 years (< 80) and those 80 years and more (80+), and compared with regard to the type of surgery performed, the patient's race, the seniority of the surgeon, the patient's disease, the operation performed and the postoperative morbidity and mortality. In addition, patients undergoing major resectional surgery and patients undergoing colorectal cancer surgery were compared separately. Results : Of 2011 admissions, 88 were for patients of 80+. The male to female admission rate was 1: 0.79 in the < 80 group and 1: 1.25 in the 80+ group. More surgical procedures were performed by consultants in older patients. More emergency admissions were for 80+ patients. Rectal, sigmoid and right colonic pathology was more common in the elderly. Very few elderly patients were admitted with minor anorectal problems. Rectal prolapse and colorectal cancer were the commonest causes for admission in octogenarians. There were more pulmonary and cardiovascular postoperative complications in 80+ patients. Urinary tract infections were also more common. The postoperative mortality rate was higher in older patients (7.9 vs 1.4%). Four hundred and sixty-two patients underwent major resectional surgery and 45 were 80+. Surgery for diverticular disease was more frequent in younger patients (13.4 vs 2.2%) and cancer surgery in older patients (93.3 vs 70.5%). The postoperative mortality rate was higher in the elderly (11.1 vs 3.6%). Three hundred and thirty-six major resections were for cancer and 42 were 80+. Emergency surgery was performed more commonly in the older group (38.1 vs 14.9%). The rate of advanced disease seemed to be similar in both groups. The postoperative death rate was higher in the elderly (11.9 vs 3.4%). Conclusions : Elderly patients were more likely to die from cardiopulmonary problems after surgical interventions than either from their primary disease or from the surgery undertaken for it. Good postoperative cardiopulmonary support should thus be provided for all such patients.     

Lung cancer surgery: the first 60 days. A population-based study.

OBJECTIVE: The postoperative mortality following lung cancer surgery is relatively high. The purpose of the present study was to identify preoperative risk factors as well as fatal complications in 27 Norwegian hospitals. METHODS: In Norway, all clinical and pathologic departments submit reports on cancer patients to the Cancer Registry of Norway. The Registry also has a law-regulated authority to collect supplemental information regarding diagnosis, treatment, and outcome for all cancer patients from the hospitals in charge. This investigation included all patients who died within 30 and 60 days after resection of lung cancer in the period 1993-2002. RESULTS: During the investigation lung cancer was diagnosed in 19,582 patients, 3224 (16.5%) were treated by surgery. The resection rate was almost similar in the two sexes, but postoperative mortality in women was less than half compared to men. Total mortality was 5% and 8% after 30 and 60 days, respectively. Bilobectomy and pneumonectomy were most risky with a mortality rate of about 10% within 60 days. In patients more than 70 years of age, there was a considerably higher frequency of pneumonectomy in men compared to women. Dominating causes of death were pneumonia with respiratory failure and cardiac events. Other identifiable causes were surgical hemorrhage and bronchopleural fistula. CONCLUSIONS: In this population-based, unselected series, the postoperative mortality was relatively high, and increased markedly in patients older than 70 years. Pneumonectomy in patients older than 70 years should only be performed when heart-lung function is found to be acceptable following full pulmonary function testing and thorough preoperative assessment of cardiovascular risk factors.