高龄结直肠癌患者急性左半结肠梗阻的外科治疗

目的 探讨高龄结直肠癌致急性左半结肠梗阻患者的外科治疗方法。方法 对31例75岁以上的结直肠癌致急性左半结肠梗阻患者的急诊外科治疗资料进行回顾性分析。结果 31例行急诊手术治疗，其中采用Mile‘s术2例，Ⅰ期切除吻合术4例，Ⅱ期切除吻合术2例，Hartmman术23例，23例中有19例于首次术后2－3周内安全施行造口回纳术，4例自愿永久造口，无手术死亡病例。结论 （1）高龄不是急诊手术的危险因素。积极的围手术期治疗可以降低并发症的发生率。（2）在急诊手术中，主要目的是切除肿瘤、解除梗阻。根治性切除不是努力追求的目标。（3）Hartmman术式较其它常用术式更适合于高龄急性左半结肠癌性梗阻患者的病理生理要求。

Surgical Management of the Elderly Left Colonic Obstruction Caused by Colorectal Carcinoma

Objective To explore surgical management of the elderly acute left colonic obstruction caused by colorectal carcinoma.Methods 31 cases of more than 75 years old with acute carcinomatous colonic obstruction were analyzed retrospectively.Results All cases chose emergency operation,2 cases underwent Miles procedure,4 cases received one stage resection and anastomosis and 2 cases two stage resection and anastomosis,23 cases Hartmanns.19 cases of Hartmanns's underwent colostomy closure operation saftly after 2 to 3 weeks of first operation.4 cases underwent permanent colostomy.There were no deaths from operation.Conclusion In emergency operation,it is important to resect tumor and to eliminate acute bowel obstrution,not radical resection.Hartmann's procedure is fitter to manage the elderly acute carcinomatous obstruction.