老年患者结肠癌合并肠梗阻急诊切除加Ⅰ期吻合45例报告

Report of Acute One-stage Anastomosis for Obstructive Colonic Cancer in 45 Elderly Patients

目的探讨结肠癌合并肠梗阻老年患者的急诊处理方法及结局。方法选取北京世纪坛医院收治45例结肠癌合并肠梗阻的老年患者。其中,左半结肠25例,右半结肠20例,均急诊行Ⅰ期吻合术,术中肠道灌洗,对术中污染的8例患者予以切口敞开,术后4～5d再次缝合。结果所有Ⅰ期吻合的患者均无吻合口瘘发生,痊愈出院,左半结肠与右半结肠梗阻在围手术期合并症上无明显差异,切口Ⅲ期缝合可以缩短切口愈合时间。结论如病例选择得当,左半结肠合并肠梗阻者可以同右半结肠一样,进行肿瘤切除后Ⅰ期吻合。

Objective To investigate the management and prognosis of emergent colon obstruction with cancer. Methods Fortyfive elderly cases with bowel obstruction caused by colonic cancers were recruited during the past five years, all of whom were treated with intraoperative decompression, on-table lavage, resection and anastomosis. Among them, 25 tumors were located on the left side of the colon, while 20 on the right. Concerning the heavy contamination during operation, 8 wounds were left open and dressing changing for 4 - 5 days before ternary closure. Results There were no anastomotie leakage observed, all patients were safely discharged, there was no significant difference in the postoperative complications between right or left side bowel obstruction, and ternary wound closure shortened its healing process. Conclusion Primary resection and anastomosis is acceptable for emergency colonic obstruction both for left and right sides in elderly patients.