老年梗阻性结直肠癌临床处理探讨

目的:探讨老年结、直肠癌致急性肠梗阻的围手术期处理和手术方式个体化的意义。方法:回顾性分析我院1991年～2002年手术治疗老年结、直肠癌致急性肠梗阻68例的临床经验。结果:一期切除吻合41例(其中吻合器吻合15例);二期切除2例,分别为盲肠造口和横结肠造口术后;Hartmann术15例;永久结肠造口术8例;回肠横结肠侧侧吻合术2例。术后死亡率为8.8％(6/68)例,一期切除吻合口漏发生率为7.3％(3/41)。结论:对老年结、直肠癌致急性肠梗阻患者,应实行手术方式的个体化,根据患者全身及局部条件,选择合理的术式。重视围手术期处理,并做好术中肠道灌洗,急诊行左半结肠切除,是可以一期愈合的。使用吻合器可缩短手术时间,且并不增加吻合口漏的发生率。

Management of Acute Obstruction due to Carcinoma of the Colon and Rectumin Elderly Patients

Objective: To evaluate perioperative management and individualization of operation mode of acute obstruction due to colorectal carcinoma in elderly patients. Methods:68 elderly patients with acute obstruction caused by colorectal carcinoma treated with operation at our hospital from 1991 to 2002 were retrospectively reviewed. Results: Immediate colectomy and primary anastomosis were performed in 41 cases (15 performed by anastomat), second - stage resection and anastomosis were performed in 2 cases after cecostomy and transverse colostomy respectively, Hartmann operation 15 cases, permanent colostomy 8 cases and side-to -side ileotransversostomy 2 cases. The mortality rate after operation was 8.8% (6/68). The incidence of anastomoses leak after single - stage resection and anastomosis was 7. 3% (3/41). Conclusion: The management of acute colon obstruction caused by colorectal cancer in elderly patients depends on general condition of the patient and local manifestation of the tumor. Individualization of operation mode should be performed on these patients. Special attention should be paid to perioperative management and sufficient colon douche should be performed during operation. The single - staged resection and anastomosis of left hemicolon may be safe and suitable. The use of anastomat can shorten operation time and do not increase the incidence of anastomoses leak.