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目的:探讨老年结直肠癌并急性肠梗阻的处理原则和方法。方法:回顾性分析10年间收治的78例(70~80岁)结直肠癌并急性肠梗阻的临床资料。78例中Dukes B期20例,C期18例,D期40例。全部患者经手术治疗,包括急诊手术46例,择期性手术32例。采用右半结肠一期切除肠吻合治疗30例,左半结肠一期切除吻合40例。Hartmann 5例,Di×on手术2例,肿瘤近端肠管造瘘1例。结果:术后出现并发症16例(20.5%)21例次,包括切口感染14例次,腹腔感染5例次和吻合口瘘2例次,死亡3例(3.85%),75例(96.2%)痊愈出院。结论:对于急性结直肠癌性梗阻除非有急诊手术指征,应首先采用非手术治1~2 d,尽可能转为择期手术;一期切除吻合治疗结直肠癌并发急性梗阻,是方便可行而安全有效的方法,加强围手术期处理是手术成功的关键。
Objective: To investigate the treatment principles and methods of senile colorectal cancer with acute intestinal obstruction. Methods: The clinical data of 78 patients (70-80 years old) with colonic cancer and acute intestinal obstruction who were treated in 10 years were retrospectively analyzed. 78 cases of Dukes B in 20 cases, C in 18 cases, D in 40 cases. Surgical treatment of all patients, including emergency surgery in 46 cases, 32 cases of elective surgery. A right colon resection of intestinal anastomosis in the treatment of 30 cases of the first half of the left colon resection and anastomosis in 40 cases. Hartmann 5 cases, Di × on surgery in 2 cases, 1 case of tumor proximal intestinal fistula. Results: Sixteen patients (20.5%) had 21 cases of postoperative complications, including 14 cases of incision infection, 5 cases of abdominal infection and 2 cases of anastomotic fistula, 3 deaths (3.85%) and 75 cases (96.2% ) Cured and discharged. Conclusion: For acute colorectal cancer obstruction unless there is an indication of emergency surgery, non-surgical treatment should be the first 1 ~ 2 d, as far as possible switch to elective surgery; a resection and anastomosis of colorectal cancer complicated by acute obstruction, is convenient and feasible Safe and effective way to strengthen perioperative management is the key to successful operation.