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目的探讨高龄梗阻性结肠癌的临床特点、外科治疗策略,提高围手术期处理水平。方法对我院自1997年1月至2007年1月收治的112例70岁以上经手术治疗的梗阻性结肠癌病例的临床资料进行回顾性分析。结果入院前误诊47例(42.0%);急性梗阻72例(64.3%),慢性梗阻40例(35.7%);Dukes C期82例(73.2%),Dukes D期30例(26.8%);根治性切除70例(62.5%),姑息性切除32例(28.6%),结肠造口4例(3.6%),捷径手术6例(5.4%);一期切除吻合69例(61.6%);伴发其他疾病103例(92.0%);发生并发症34例(30.4%);围手术期死亡4例(3.6%);平均生存期23.4个月。结论高龄结肠癌误诊率高,手术切除仍是主要的治疗手段。选择“个体化”治疗方案、积极处理伴发病和加强围手术期营养支持治疗是改善其预后的关键。
Objective To explore the clinical features and surgical treatment strategies of obstructive colon cancer in advanced age and improve the perioperative management. Methods We retrospectively analyzed the clinical data of 112 cases of obstructive colon cancer treated by surgery from January 1997 to January 2007 in our hospital. Results Before admission, 47 cases (42.0%) were misdiagnosed; 72 cases (64.3%) were acute obstruction, 40 cases (35.7%) were chronic obstruction; 82 cases (73.2%) were Dukes C stage, 30 cases (26.8%) were Dukes D stage; 70 cases (62.5%) were excised, 32 cases (28.6%) were palliatively removed, 4 cases (3.6%) were colostomy, 6 cases (5.4%) were treated with short cuts, and 69 cases (61.6%) were performed with one stage resection and anastomosis; 103 cases (92.0%) had other diseases; 34 cases (30.4%) had complications; 4 cases (3.6%) died during perioperative period; the average survival period was 23.4 months. Conclusions The misdiagnosis rate of colon cancer in elderly patients is high, and surgical resection is still the main treatment method. Selecting the “individualized” treatment program, actively dealing with comorbidities and strengthening perioperative nutritional support treatment are the key to improving its prognosis.