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目的:总结老年患者结直肠癌并急性穿孔的诊断与治疗方法。方法:回顾性分析5例老年结直肠癌并发急性穿孔患者临床资料。结果:术前误诊2例;4例一期切除肿瘤行近端肠管造瘘术,1例行穿孔修补乙状结肠袢式双腔造瘘术。围手术期死亡1例,术后1 a内死亡1例,3~4 a死亡2例,1例随访15个月仍存活。结论:老年结直肠癌并急性穿孔易误诊,并发症多,病情发展迅速,应及早诊断,及时手术治疗,不主张一期肠吻合术。
Objective: To summarize the diagnosis and treatment of colorectal cancer in elderly patients with acute perforation. Methods: The clinical data of 5 elderly patients with colorectal cancer complicated with acute perforation were retrospectively analyzed. Results: 2 cases were misdiagnosed before operation, 4 cases with one stage resection of proximal gingival fistula, and 1 case with perforation to repair sigmoid colon double-chamber ostomy. 1 patient died during perioperative period, 1 patient died within 1 year after operation, 2 patients died from 3 to 4 years and 1 patient survived 15 months after follow-up. Conclusion: Acute perforation of colorectal cancer is easy to be misdiagnosed in elderly patients. There are many complications and rapid progression of the disease. Early diagnosis and timely surgical treatment should not be advocated. No primary intestine anastomosis should be advocated.