老年人结肠癌并急性梗阻32例临床分析

Study on the diagnosis and treatment of elderly patients with colonic carcinoma and acute intestinal obstruction

目的:探讨老年人结肠癌并急性梗阻的诊断与治疗方法。方法:对我院2003～2008年收治的32例60岁以上结肠癌并急性梗阻患者的临床资料进行回顾性分析,32例中Ⅰ期切除24例,Ⅱ期切除6例,捷径手术2例。结果:32例中16例(50%)术后发生并发症,包括切口感染2例,肺部感染6例,吻合口瘘2例,腹腔感染4例,肠梗阻2例。住院期间死亡3例(9.3%),住院11～28d,平均18d。结论:肠梗阻明显者一般通过纤维结肠镜即可明确诊断,术前诊断不明确患者应考虑给予肛门指诊和纤维结肠镜或CT检查。手术切除是老年结肠癌患者最佳的治疗方法,应加强围手术期管理,合理处理并存病以及选择适宜的麻醉和手术方式是提高疗效的关键。

Objective： To investigate the diagnosis and treatment of elderly patients with colonic carcinoma and acute intestinal obstruction. Methods： Clinical data of 32 patients aged 60 years or older with colonic carcinoma and acute intestinal obstruction who were diagnosed and treated from 2003 to 2008 were studied retrospectively. Of the surgical treatment of the 32 patients, 24 patients underwent stage Ⅰ resection, 6 patients underwent stage Ⅱ resection, two cases underwent short-cut operation. Results ： Sixteen （50%） out of the 32 patients occurred postoperative complications, including incision infection in 2 cases, pulmonary infection 6 cases, anastomotic leakage 2 cases, abdominal cavity infection 4 cases, intestinal obstruction 2 cases; 3 cases （9.3%） died during hospitalization, and the average time of hospitalization was 18 d （11- 28 d）. Conclusion： Diagnosis of overt intestinal obstruction can be established by fiber colonoscopy, if preoperative diagnosis is inconclusive, digital rectum examination, fiber colonoscopy and CT may be considered. Surgical resection of colon carcinoma in elderly patients is the best method of treatment. Strengthened perioperative management, reasonabe treatment of concomitant diseases, and wise choice of appropriate anesthesia and surgical procedure play an important role in the enhancement of effect.