老年结肠癌并发急性梗阻106例外科治疗分析

Surgical treatment and perioperative management of acute obstructive colon cancer in elderly:a report of 106 cases

目的探讨老年结肠癌并发急性梗阻的临床特点、诊治策略、围手术期处理和术式选择原则。方法回顾性分析1996年5月至2008年5月外科手术治疗106例老年结肠癌并发急性梗阻患者的临床资料。结果术前明确诊断98例(92.4%),并发肠穿孔14例术前全部确诊;Ⅰ期切除吻合81例(76.5%),Ⅰ期切除近端造瘘21例(19.8%);DukesD期4例(3.8%)仅行近端结肠造瘘;发生切口并发症25例(23.6%),其中感染10例,裂开15例,均治愈;发生吻合口瘘3例,经腹腔灌洗引流治愈1例;术后死亡5例(4.7%),2例死于吻合口瘘,3例死于感染和多器官功能衰竭。术后随访101例,平均生存期21.6个月。结论老年结肠癌并发急性梗阻临床表现复杂,并发症发生率高,治疗以外科手术为主,加强围手术期处理,合理把握手术时机以及正确选择手术方式是降低手术风险、减少并发症、保证治疗效果的关健。

Objective To investigate the clinical characteristics and surgical treatment of obstructive colon cancer in the elderly patients in order to elevate the management level of perioperation. Methods The data of 106 cases treated by surgical treatment from May 1996 to May 2008 were analyzed retrospectively. Results The pre-operative diagnosis rate was 92.4%（98/106）,14 patients companied enterobrosis; 81 patients （76.5%） were resected in one -stage excision; 21 patients （19.8%） were resected in one-stage excision plus proximate colostomy ; 4 patients （3.8 %） were in Dukes D and treated by first-stage simple colostomy; 25 patients （23.6%） had incisal opening complications, 10 patients had incisal opening infection, 15 patients had incisal opening disruption;3 patients had anastomotic leakage; 5 patients died after operation, 2 patients died from anastomotic leakage, 3 patients died from multiple organ failure. 101 patients were followed up and the mean survival time was 21.6 months. Conclusion The acute obstructive colon cancer in the elderly is often companied by multi diseases and has complex clinical manifestation. The surgical resee tion is a major procedure for obstructive colon cancer in the elderly patients. It is a key factor for treatment to choose the timing of operation and modus operandi and positive perioperative treatment.