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目的研究高龄结肠癌并发急性肠梗阻的临床特点及术式选择。方法回顾分析2008年1月至2011年12月诊治的35例高龄结肠癌并发急性肠梗阻患者临床资料,分析患者疗效及术后并发症,比较手术前后生存质量差异。结果本组患者均行急诊手术,其中行一期标准结肠癌根治术、肠吻合术16例,一期造口、二期切除吻合术9例,姑息性切除7例,永久性造口或肠短路吻合术4例。痊愈出院31例(88.6%),术后发生切口并发症8例,其中切口感染3例,切口裂开5例;发生吻合口瘘3例。术后死亡4例,其中1例死于吻合口瘘,1例死于肺部感染,2例死于腹腔感染。患者术后的生理状况、情感状况和附加关注评分显著低于手术前(P<0.05),社会/家庭状况和功能状况显著高于手术前(P<0.05),术后患者生存质量显著高于术前(P<0.05)。结论高龄结肠癌并发急性肠梗阻手术风险大,死亡率高,应结合患者自身状况及肿瘤位置选择正确手术方式。
Objective To study the clinical features and surgical options of elderly colon cancer with acute intestinal obstruction. Methods The clinical data of 35 elderly patients with colon cancer complicated with acute intestinal obstruction diagnosed and treated from January 2008 to December 2011 were retrospectively analyzed. The curative effect and postoperative complications were analyzed. The differences of quality of life before and after operation were compared. Results This group of patients underwent emergency surgery, including a standard colon cancer radical surgery, intestinal anastomosis in 16 cases, a stoma, two resections and anastomosis in 9 cases, palliative resection in 7 cases, permanent stoma or intestine Short circuit anastomosis in 4 cases. Thirty-one patients were discharged (88.6%). There were 8 cases of incision complications after operation, including 3 cases of incision infection and 5 cases of incision incision; 3 cases of anastomotic fistula occurred. Four patients died after operation, of which 1 died of anastomotic fistula, 1 died of pulmonary infection and 2 died of intra-abdominal infection. The postoperative physiological status, emotional status and additional attention scores were significantly lower than before surgery (P <0.05), social / family status and functional status were significantly higher than before surgery (P <0.05), postoperative quality of life was significantly higher Preoperative (P <0.05). Conclusion The elderly colon cancer with acute intestinal obstruction risk and mortality is high, patients should be combined with their own status and tumor location to choose the correct surgical approach.