老年结肠癌伴急性肠梗阻的外科治疗体会(附45例报告)

Surgery treatment of colon cancer with acute ileus in old patients(45 cases reported)

目的探讨老年结肠癌并发急性梗阻的临床特点、围手术期处理和术式选择。方法回顾性分析45例手术治疗的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39例(86.67%),并发肠穿孔6例术前全部确诊;Ⅰ期切除吻合26例(57.78%),Ⅰ期切除近端造瘘7例(15.56%);分期手术9例(20.00%);DukesD期3例(6.67%)仅行近端结肠造瘘;发生切口并发症11例(24.44%),其中感染4例,裂开7例,均治愈;发生吻合口瘘2例,经腹腔灌洗引流治愈1例;术后死亡3例(6.67%),分别死于吻合口瘘、感染和多器官功能衰竭。42例术后得到随访,平均生存期(23.40±4.56)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、减少并发症和保证治疗效果的关键。

Objective To investigate the clinical characteristics,perioperative surgical treatment and choice of operative method in the old patients with colon cancer with acute ileus.Methods The data of 45 cases of the old patients with colon cancer with acute ileus treated by surgical treatment were analyzed retrospectively.Results Thirtynine cases were diagnosed（86.67%） before operation,including 6 patients with enterobrosis;26 patients（57.78%） were primary resected,including 7 patients（15.56%） with proximal colostomy ;9 patients（20.00%） were secondary resected;3 patients（6.67%） with the stage of Dukes D were treated with proximal colostomy only;11 patients（24.44%） appeared cut complications,including 4 patients with cut infection and 7 patients with cut disruption;2 patients appeared anastomotic leakage;3 patients died from anastomotic leakage,infestation and multiple organ failure respectively after operation.42 patients were followed up and the mean survival time was（23.40±4.56） months.Conclusions The old patients with colon cancer with acute ileus has complex clinical manifestation and accompanies high complication rates.Surgical resection is major treatment method,and positive perioperative treatment,correct operative occasion and proper operative method are key for reducing operative risk and complications and fixing curative effect.