老年人结直肠癌穿孔临床诊治分析

CLINICAL DIAGNOSIS AND TREATMENT OF COLORECTAL CANCER PERFORATION IN ELDERLY

目的探讨老年人结直肠癌穿孔的特点、诊断方法、术式选择及疗效和进一步提高诊治水平的措施。方法回顾性分析我院53例老年人结直肠癌穿孔患者的临床资料。结果术前明确诊断20例(37.7%)。行右半结肠癌根治性切除I期肠吻合术20例;行左半结直肠癌I期根治切除,Hartmann造口术26例;姑息性结直肠癌切除术+近端结肠造口+远端关闭术5例,单纯修补穿孔+近端结肠双腔造瘘术2例。围术期死亡9例(13.2%),44例治愈或好转。结论老年人结直肠癌合并穿孔病死率较高,误诊率较高,并发症多,要详细地采集病史、进行严格的体格检查和分析辅助检查结果,制定个体化诊疗方案,及时手术、选择合理的手术方式可减少病死率,提高生活质量。

Objective To investigate the characteristics of the perforated diagnosis, surgical method, cura- tive effect and further measures to improve the level of diagnosis and treatment in elderly patients with coin- rectal cancer. Methods Retrospective analysis from January 2000 to November clinical material of 53 cases of elderly patients with colorectal cancer perforation. Results About 37. 7% of the patients were of the preoperative diagnosis. Do right colon cancer radical resection of stage I intestinal anastomosis twenty ca- ses. Line left colorectal cancer stage I radical resection, Hartmann ostomy 23 cases）. Palliative resection of colorectal cancer in 4% Eight cases of colon cancer resection ＋ near end colostomy 3 cases, simple repair punch ＋ near end colon double cavity ostomy patients. Perioperative death was 9 cases （13. 2%）, 44 cases were cured or improved. Conclusion the elderly colorectal cancer combined perforation death is higher, the misdiagnosis rate is higher, more complications, collect detailed medical history, physical examination and analysis of auxiliary examination results, setting individualized diagnosis and treatment plan, timely surger- y, the rational choice of surgical methods can reduce mortalitv and imnrnve the rurality nf lifo