摘要
目的 探讨老年癌性结、直肠梗阻的诊治方法。方法 分析５８ 例老年癌性完全性结、直肠梗阻的临床表现，腹部Ｘ线检查、Ｂ超、ＣＴ、钡灌肠和腹腔穿刺等检查， 以及血清肌酸磷酸激酶和血清乳酸脱氢酶的测定， 对老年癌性结、直肠梗阻可能出现的绞窄性肠梗阻作出早期诊断，全面评估老年患者各脏器功能后，早期手术治疗。结果 本组５８ 例患者中有５５ 例行手术治疗。从入院至手术时间３ 小时至５ 天。术中诊断１３ 例为绞窄性肠梗阻，其中５ 例术前做出诊断，符合率３８％ 。５５ 例手术患者术后发生并发症３４ 例，死亡５ 例，病死率９ ％ ，其中绞窄性肠梗阻死亡３ 例。结论 对于老年癌性结、直肠梗阻， 能够早期并准确地认识到绞窄性肠梗阻的发生，对治疗和预后具有重要意义。
Objective To evaluate the management of large intestinal strangulation on elderly patients with mechanical bowel obstruction associated with colorectal carcinoma. Methods Fifty eight elderly patients with mechanical bowel obstruction due to colorectal carcinoma were evaluated. Patients with abdominal pain, distention, vomitting and non- exsufflation underwent following examinations, such as abdominal filmplain, ultrasonography, CT scan, barium enema and serum CKP, serum LDH. The presence or absence of strangulation was confirmed , then laparotomy was performed after preoperative evaluation. Results Fifty five of 58 patients were received surgical treatment from three hours to five days after admission.Strangulation was defined in 13 patients during operation, and five (38%) were confirmed to preoperative diagnosis. Complications occured in 34 of 55 cases undergoing operation. 5 cases died and the mortality rate was 9%. Three of 13 patients with strangulation died after operation. Conclusion An accurate and early recognition of the presence of bowel strangulation is important to the treatment and prognosis in elderly patients with mechanical large bowel obstruction due to colorectal carcinoma.
