老年梗阻性直肠癌处理方式探讨

Acute obstructive rectal cancer in the elderly patients

目的在损伤控制性外科理念指导下,探讨老年梗阻性直肠癌的合理处理方式。方法山西省人民医院结直肠肛门外科2006年1月至2009年6月收治老年梗阻性直肠癌病人20例,在损伤控制性外科理念的指导下,回顾性分析病人分阶段、分步骤处理的临床资料。结果 18例经过分阶段、分步骤的围手术期处理,肠梗阻症状缓解,并进行了限期确定性手术治疗。2例病人急诊手术造口。确定性手术后痊愈17例,1例发生吻合口瘘,经回肠末端造口后治愈。结论对于老年梗阻性直肠癌的病人,在损伤控制性外科理念的指导下,术前暂时缓解肠梗阻症状,变急诊手术为限期手术,可以提高一期手术成功率,明显改善病人预后。

Objective To investigate the rational management of acute obstructive rectal cancer in the elderly patients under “damage control surgery” （DCS） guidance. Methods The clinical data of twenty elderly patients with acute obstructive rectal cancer admitted between January 2006 and June 2009 at Shanxi Provincial People＇s Hospital were analyzed retrospectively. Results Among 20 elderly patients with obstructive rectal cancer, 18 patients were performed perioperative treatment with different stages and procedures, got symptomatic relief and were performed selective definite surgical operation. Among 18 patients performed definite operation, 17 patients were healed and anastomotic leakage occurred in 1 patient. The other 2 patients were performed ileostomy. Conclusion The perioperative management of elderly patients with acute obstructive rectal cancer under “damage control surgery” guidance can change emergency operation to selective operation and greatly improve the prognosis of elderly patients.