90例老年大肠癌致肠梗阻的临床分析

Clinical analysis of aged intestinal obstruction caused by colorectal carcinoma

目的回顾性分析老年大肠癌致肠梗阻患者的外科处理及疗效。方法对90例老年大肠癌致梗阻患者行手术治疗。结果90例患者中28例行Ⅰ期右半结肠切除,10例行Ⅰ期横结肠切除,27例行Ⅰ期左半结肠切除,18例行Ⅰ期左半结肠或直肠上段切除、近端结肠造瘘,关闭远端结肠或直肠备做Ⅱ期切除,7例肿瘤无法切除行乙状结肠或横结肠造瘘。术后并发症发生率14.4%(12/90),围术期病死率4.4%(4/90);随访统计1、3、5年生存率分别为83.6%、44.8%和32.5%。结论正确选择手术时机和合理的手术方式,加强围手术期各器官功能支持和营养代谢支持是减少死亡率、改善预后的重要环节。

Objective To investigate surgical management and curative effect of the aged intestinal obstruction caused by color- ectal carcinoma. Methods The surgery clinical data of intestinal obstruction caused by colorectal carcinoma of 90 aged cases were retrospectively analyzed. Results Of the 90 patients,28 patients underwent the first-stage right hemicolectomy, 18 patients under- went first-stage colon transversum resection, 27 patients were treated with first-stage left hemicolectomy, 18 patients with first- stage resection of left hemicolon or superior segment of rectum resection and cut-off colon/rectum distal end to prepare for the sec- ond-stage operation. 7 patients had colon sigmoideum or transversum colostomy because the tumor couldnrt be removed. 12 patients of 90（14. 4%） had postoperative complications. The operative mortality was 4.4% （4/90）. The survival rates of 1 year,3 year and 5 year were respectively 83.6%,44.8 % and 32.50%. Conclusion Choosing a correct opportunity and a rational method of operation and enhancing the perioperative supports to organs function and metabolism is important to a good prognosis with lower death rate.