58例80岁以上结直肠癌患者的临床分析

The clinical analysis of colorectal cancer in 58 patients over 80 years old

目的探讨80岁以上结直肠癌患者的临床特点及外科手术治疗效果。方法收集行外科手术治疗的58例80岁以上结直肠癌患者的临床资料,分析其临床症状、合并疾病、肿瘤部位、肿瘤大小、TNM分期、病理类型、分化程度、术后并发症及预后情况。结果58例患者均接受手术治疗,其中48例患者行根治性手术(8例患者行腹腔镜下根治术,40例患者行开腹根治术),10例患者行非根治性肠切除+造口术。患者的临床症状包括排便习惯改变,肠梗阻,腹痛,便中带血、脓或黏液,腹部包块及全身症状(食欲减退、贫血)等。11例患者未合并慢性疾病,47例患者合并慢性疾病(如高血压、冠状动脉心脏病、糖尿病、慢性阻塞性肺疾病等)。肿瘤位于结肠40例,直肠17例,直肠和乙状结肠1例;肿瘤直径﹤3cm5例,3~5cm32例,﹥5cm21例;TNM分期:Ⅰ期1例,Ⅱ期32例,Ⅲ期14例,Ⅳ期11例;病理类型:腺癌57例,黏液腺癌1例;分化程度:低分化4例,低中分化4例,中分化35例,中高分化8例,高分化7例。术后18例患者发生并发症,8例患者于围手术期死亡。结论高龄结直肠癌患者的合并疾病及术后并发症较多,应尽早诊断、积极治疗,年龄及合并多种慢性疾病不应成为手术的禁忌。

Objective To explore the clinical characteristics and effect of surgical treatment of colorectal cancer patients over 80 years old. Method This retrospective analysis included the clinical data of 58 patients over 80 years old with colorectal cancer, of which the clinical characteristics, comorbidities, tumor location, tumor size, TNM stage, pathological type, degree of differentiation, postoperative complications and prognosis were analyzed. Result All the 58 cases had received surgical treatment, among which there were 48 cases receiving radical resection(8 cases of laparoscopic radical resection, and 40 cases of laparotomy for radical resection), 10 cases were administered with non-radical enterectomy + enterostomy. The main clinical symptoms among these patients were change of bowel habits, intestinal obstruction,abdominal pain, blood, pus or mucus in stool, abdominal mass and systemic symptoms(decreased appetite and anemia).Among these patients, 11 patients had no chronic comorbidities, while 47 cases were with chronic diseases such as hypertension, coronary heart disease, diabetes mellitus, chronic obstructive pulmonary disease. Forty cases had their tumor located in colon, 17 in rectum, and 1 in rectum and sigmoid colon;as to tumor size, 5 cases were with tumor diameter <3 cm, 32 cases with 3-5 cm, and 21 cases with > 5 cm lesions;there was 1 case of TNM stage Ⅰ, 32 cases of stage Ⅱ, 14 cases of stage Ⅲ, and 11 cases of stage IV;pathological types: 57 cases were with adenocarcinoma, and 1 case was of mucinous adenocarcinoma;degree of differentiation: 4 cases of poor differentiation, 4 cases of poor to moderate differentiation, 35 cases of moderate differentiation, 8 cases of moderate to high differentiation, and 7 cases of high differentiation.Postoperative complications occurred in 18 cases and there were 8 cases of death during perioperative period. Conclusion Elderly colorectal cancer patients are with relatively more comorbidities and postoperative complications, thus they should be diagnosed and actively treated as early as possible, age and multiple chronic diseases should not be contraindications for surgery.