老年结直肠癌合并急性肠梗阻:附116报告

The treatment of colorectal carcinoma with acute colonic obstruction in the elderly:a report of 116 cases

目的探讨老年结直肠癌合并急性肠梗阻的处理原则和方法。方法回顾性分析5年间收治的116例老年(≥60岁)结直肠癌并发急性肠梗阻患者的临床资料。全组右半结肠癌并梗阻39例,左半结肠癌并梗阻64例,直肠癌并梗阻13例。采用右半结肠一期切除吻合治疗39例,左半结肠一期切除吻合62例,Hartmann手术9例,Dixon手术4例,肿瘤近端肠管造瘘2例。结果术后出现并发症17例(14.7%)21例次,包括切口感染14例次,腹腔感染5例次和吻合口瘘2例次,死亡1例(0.9%)。115例(99.1%)痊愈出院。结论一定条件下,一期切除吻合治疗结直肠癌并发急性肠梗阻,是方便可行而安全有效的方法。

Objective To evaluate the treatment of colorectal carcinoma with acute colonic obstruction in the elderly. Methods The clinical data of 116 elderly patients undergoing emergency operation for acute colonic obstruction due to colorectal carcinoma were analyzed retrospectively. The patients were treated in recent 5 years. There were 39 elderly patients with right-side colonic lesion, 64 cases with left-side colonic lesion and 13 elderly patients with rectal lesion. All patients received emergency operation. One stage tumor resection and anastomosis was performed in 39 cases with right-side colonic lesion and in 62 cases with left-side colonic lesion, Hartmann operation in 9 cases, Dixon operation in 4 cases and proximal colostomy in 2 cases. Results Postoperative complications occurred in 17 cases （ 14.7 % ） , including wound infection, intraperitoneal sepsis and intestinal fistula. One hundred and fifteen cases recovered （99.1%）, but there was one perioperative death. Conclusions Under certain conditions, one stage tumor resection is feasible and safe for acute colonic obstruction due to colorectal carcinoma in elderly patients.