老年人结肠癌并急性肠梗阻的外科处理

Surgical treatment of obstructive colon cancer in elderly patients

目的总结老年人结肠癌并急性肠梗阻外科处理体会。方法回顾性分析近5年来老年人结肠癌并急性肠梗阻89例;分析其发病情况、术前诊断和外科处理情况。结果老年人结肠癌并急性肠梗阻就诊时间晚,术前诊断难以定性定位;右半结肠癌梗阻均作Ⅰ期切除吻合术,无手术并发症;左半结肠Ⅰ期切除吻合术后并发肠瘘3例,切口感染8例,腹腔感染4例,死亡2例,1例死于感染性休克,1例死于多脏器功能衰竭。结论老年人结肠癌并急性肠梗阻就诊时间晚,术前CT检查对初步明确梗阻部位及病因有一定的帮助。术中应视具体情况合理选择术式,同时重视围手术期处理。

Aim To summarize the experience of surgical treatment of obstructive colon cancer in elderly patients.Methods 89 cases of obstructive colon cancer in the past 5 years were choosed,and the incidence,preoperative diagnosis and surgical treatment situation were analyzed retrospectively.Results The elderly patients with obstructive colon cancer often can＇t receive early treatment.Preoperative diagnosis was often low on localization and quality decision.Right-side colon cancer obstruction underwent a one-stage resection and there were no postoperative complications.Left-side colon cancer obstruction underwent a one-stage resection.Three cases developed fistula,eight cases wound infection,four cases intra-abdominal infection,and two cases died.One patient died of septic shock and the other patient died of multiple organ failure.Conclusion The elderly patients with obstructive colon cancer often receive treatment lately.Preoperative CT examination is often helpful for initial location and cause of obstruction.A reasonable treatment should be chosed for the operation and the attention is required for perioperative management.