高龄患者左半结肠癌梗阻的外科治疗

Surgical Treatment for Aged Patients with Obstruction by Left Hemicolon Cancer

目的:探讨高龄患者左半结肠癌伴梗阻外科治疗原则。方法:回顾分析1988年6月—2003年6月32例高龄左半结肠癌伴梗阻患者行手术治疗的临床资料。结果:32例均行手术治疗,其中行一期切除吻合19例;肿瘤一期切除结肠近侧断端造口、远侧断端缝闭4例;先行结肠造口,二期行切除手术3例;肠捷径手术2例;永久性结肠造口术4例。术后发生吻合瘘2例,肺部感染4例,切口感染7例,切口裂开2例。1例死于多器官功能衰竭,其它病例均通过非手术治疗治愈。一期切除吻合术后5年生存率31.6%(6/19),未行肿瘤一期切除者5年生存率0%。结论:一期切除吻合术治疗高龄左半结肠癌伴梗阻患者是可行的,而选择合理手术方式,正确的术中操作和围手术处理能提高疗效,改善患者生活质量。

Objective： To explore the principle of surgical treatment for aged patients with obstruction by left hemicolon cancer. Methods：Clinical data of 32 aged patients with obstruction by left hemicolon cancer from June 1988 to June 2003 were analyzed retrospectively. Results： Nineteen patients were treated with one-stage left hemicolectomy and anastomosis, 4 patients with neostomy at the proximal end and suture at the distal end, 3 patients with two stage left hemieolectomy and anastomosis, 2 pa tients were carried out bypass operation and 4 patients were performed permanent stoma. Complications occurred in 2 patients with anastomotic leakage, 4 patients with pulmonary infection, 7 patients with infection of incisional wound, 2 patients with disruption of wound. All patients with those complications were cured except one who died of 1 multiple organ dysfunction syndrome. The rate of survival for 5 years in patients with one-stage left hemicolectomy and anastomosis was 31.6% （6/19） and no one survived for 5 years without that operation. Conclusion： one-stage left hemicolectomy and anastomosis is a practical and an effective way of treating aged patients with obstruction by left hemicolon cancer. It can also enhance treatment out come and the quality of life through appropriate operative procedure, skillful technique and perioperative management.