老年结直肠癌急性肠梗阻手术治疗分析

Analysis of surgical management in elderly patients with obstructive colorectal carcinoma

目的探讨老年结、直肠癌急性肠梗阻的手术治疗。方法分析30例老年结、直肠癌急性肠梗阻的手术治疗,其中肿瘤一期切除吻合9例,一期切除二期吻合21例,比较一期吻合和二期吻合的术后并发症及生存情况。结果全组无术中及围术期死亡,术后发生吻合口瘘1例;一期吻合组切口感染率(44.4%)明显高于二期吻合组(4.8%)(P=0.033),吻合口瘘发生率、体温38.0℃以上持续时间以及重要脏器并发症发生率两组间差异均无统计学意义(P>0.05);一期吻合组1、3、5年生存率分别为88.9%、22.2%、11.1%;二期吻合组1、3、5年生存率分别为95.0%、27.1%、10.8%,两组生存曲线比较差异无统计学意义(P=0.900)。结论老年结、直肠癌急性肠梗阻手术治疗中,一期切除肿瘤后作一期或二期肠吻合,不会影响患者的长期生存率,但二期肠吻合可以减少术后并发症。

Objective To investigate the surgical management of elderly patients with obstructive colorectal carcinoma. Methods Analysed the surgical management of 30 cases with obstructive colorectal carcino- ma, who were divided into the group of 9 cases undergone stage Ⅰ resection and anastomosis and the group of 21 cases undergone stage Ⅱ anastomosis. Studied the difference of complication and survival by comparison be- tween the two groups. Results All the cases had no intraoperative or perioperative death, anastomosis fistula happened in Ⅰ case. The incision infection rate（44. 4% ） of stage Ⅰ anastomosis group was statistically higher than that（4. 8% ）of stage Ⅱ anastomosis group（ P = 0. 033 ） , but the difference of anastomosis fistula, course of more than 38. 0℃ and complication in main organs were not statistically significant between the two groups（ P 〉0. 05）. The survival rate of 1,3 and 5 year were 88.9%, 22. 2% and 11.1% in stage Ⅰ anastomosis group respectively, and 95.0% ,27. 1% ,10. 8% in stage Ⅱ anastomosis group respectively, the difference in Kaplan- Meier curves between two groups had no statistical significance. Conclusion Stage Ⅰ or stage Ⅱ anastomosis after tumor resection in obstructive colorectal carcinoma do not result in efficiency to long survival, stage Ⅱ anastomosis can reduce postoperative complications.