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目的:探讨高龄患者左半结肠癌伴梗阻外科治疗原则。方法:回顾分析1988年6月—2003年6月32例高龄左半结肠癌伴梗阻患者行手术治疗的临床资料。结果:32例均行手术治疗,其中行一期切除吻合19例;肿瘤一期切除结肠近侧断端造口、远侧断端缝闭4例;先行结肠造口,二期行切除手术3例;肠捷径手术2例;永久性结肠造口术4例。术后发生吻合瘘2例,肺部感染4例,切口感染7例,切口裂开2例。1例死于多器官功能衰竭,其它病例均通过非手术治疗治愈。一期切除吻合术后5年生存率31.6%(6/19),未行肿瘤一期切除者5年生存率0%。结论:一期切除吻合术治疗高龄左半结肠癌伴梗阻患者是可行的,而选择合理手术方式,正确的术中操作和围手术处理能提高疗效,改善患者生活质量。
Objective: To investigate the principle of surgical treatment of left-sided colon cancer with obstruction in elderly patients. Methods: Retrospective analysis of June 1988 - June 2003 32 cases of advanced left colon cancer with obstruction in patients with surgical treatment of clinical data. Results: Thirty-two cases underwent surgical resection, of which 19 cases were performed resection and anastomosis in one stage. One stage resection of colostomy was performed in the proximal stump of the tumor and 4 cases of distal stump seams. The first colostomy was performed and the second stage was performed Cases; short bowel surgery in 2 cases; 4 cases of permanent colostomy. There were 2 cases of anastomotic fistula, 4 cases of pulmonary infection, 7 cases of incision infection and 2 cases of incision rupture. One patient died of multiple organ failure, and the other cases were cured by non-surgical treatment. The 5-year survival rate was 31.6% (6/19) after one-stage resection and anastomosis, and the 5-year survival rate was 0% without primary tumor resection. Conclusions: One-stage resection and anastomosis is feasible for patients with advanced left colon cancer with obstruction. Choosing a reasonable surgical approach, proper operation and perioperative management can improve the curative effect and improve the quality of life of patients.