老年人结肠癌并发急性肠梗阻的治疗体会

Treatment of aged patients with colon cancer complicated by acute obstruction

目的探讨老年人结肠癌并发急性肠梗阻的处理原则和方法。方法回顾性分析1997年1月至2006年12月收治的367例60岁以上结肠癌合并肠梗阻患者的临床资料。手术治疗348例，非手术治疗19例。结果手术治疗的348例中330例痊愈出院（89．9％），其中41例经急诊内镜放置支架、充分评估病情准备肠道后经手术全部痊愈出院；18例（4．9％）围手术期死亡；161例因远处转移、多系统器官功能衰竭等死亡。术后并发吻合口漏14例（3．8％）；切口感染2l例（5．7％）。非手术治疗的19例均后期因远处转移、多系统器官功能衰竭等死亡。结论重视老年结肠癌并发急性肠梗阻的围手术期处理，选择合适的外科处理方法是提高疗效、减少并发症的关键。

Objective To investigate the surgical management of acute colonic obstruction caused by colon carcinoma in the elderly. Methods Clinical data of 367 patients over 60 years old with acute intestinal obstruction caused by colon cancer during January 1997 to December 2006 were retrospective analyzed. Results A total of 348 cases （ 94. 8% ） were subjected to surgical treatment, and 330 cases （89.9%） were discharged. Among them after endoscopic stent placement by emergency department, full assessment of disease, intestinal preparation and surgery,41 cases were cured and discharged; 18 cases （4.9%） died perioperatively; 161 cases died from distant metastasis and multisystem organ failure. Postoperative anastomotic fistula occurred in 14 cases （ 3.8% ） , wound infection in 21 cases（5.7% ）. Nineteen cases with non - surgical treatment died from distant metastasis, multisystem organ failure, etc. Condusion Particular attention should be paid to perioperative management of acute colonic obstruction caused by colon carcinoma in the elderly. Appropriate surgical strategy is the key to better efficacy and fewer complications.