高龄结肠癌患者的外科治疗和围手术期处理

Surgical treatment and perioperative period management for elderly patients with colonic carcinoma

目的探讨高龄结肠癌患者的临床特点及围手术期治疗的有关问题。方法回顾性分析70岁以上结肠癌患者117例的外科治疗资料。结果患者中43例入院前未及时诊治或延误诊治(约36.75%),84例术前存在各种合并症(71.79%),81例行根治性切除(69.23%),36例行各类姑息性手术(30.77%),39例术后存在并发症(33.33%),5例围手术期死亡(病死率4.27%)。结论高龄并非是结肠癌手术的危险因素。重视合并症的诊断和治疗、充分的术前准备、合理选择手术时机与手术方式、恰当的老年人手术原则,加强术中与术后监测和防治术后并发症,是减少高龄结肠癌手术后并发症和病死率,提高切除率、生存率和改善生存质量的关键。

Objective To explore the clinical characters and perioperative period management for elderly patients with colonic carcinoma. Methods 117 cases of elderly patients aged 70 years and over who received operation for colonic carcinoma were analyzed retrospectively. Results 43 casess delayed or missed diagnosis （36.75 % ）. 84 cases had other diseased （71.79 % ）. 81 cases underwent radical resection （69.23 % ）. 36 cases underwent palliative operation （30.77%）. 39 cases had one or several complications （33.33 % ）, of which 5 cases died during perioperation period（mortality rate 4.27 % ）. Conclusion Old age is not the determining factor of operative crisis as the treatment for colonic carcinoma patients.In order to enhance resection rate especially radical resection rate and survival rate, to diminish postoperative complications and mortality, and thus to improve the quality of life for the elderly colonic carcinoma patients, a series of measures must be taken.First, diagnosis and treatment of the associated conditions must be emphasized. Second, full preoperative preparations with appropriate choice of the time and procedure for operation, as well as exact operation principles must be followed. Finally, intensive monitoring during the perioperative period and prevention and treatment of postoperative complications were also important factors to be considered.