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老年急性结肠癌梗阻临床常见,但其早期确诊率不高,手术方式也不一致。本文通过对32例老年结肠癌梗阻病人的诊断和治疗提出以下看法:对于老年人无腹部手术史,除外粘连性肠梗阻者,一旦出现腹部胀痛,大便习惯改变,即应高度怀疑本病,应进一步检查以便确诊,在无法检查情况下,只要有手术指征就应积极剖腹探查,而不应盲目等待,观察,丧失手术时机。 对于右半结肠癌所致的急性梗阻,手术方式已趋于一致,即行一期右半结肠切除,回横结肠吻合术。对于左半结肠癌所致的急性梗阻以往主张:先行一期造瘘或切除肿瘤后造瘘解除梗阻,二期手术吻合。我们对11例左半结肠癌所致梗阻病人于急诊下行一期肿瘤切除一期结肠吻合术,术后仅1例因梗阻时间较长,合并贫血,低蛋白症而出现吻合口瘘,其余10例均恢复良好,无术后并发症发生。
Acute obstructive colon cancer is common in the elderly, but its early diagnosis rate is not high, and the surgical approach is also inconsistent. This article presents the following views on the diagnosis and treatment of 32 elderly patients with colon cancer obstruction: For the elderly without abdominal surgery history, except for adhesive intestinal obstruction, once the abdominal pain, bowel habits change, that should be a high degree of suspicion of the disease, Should be further examined in order to confirm the diagnosis, in the case of inability to check, as long as there are indications for surgery should be actively laparotomy exploration, rather than blindly waiting, observation, loss of surgical timing. For acute obstruction caused by right colon cancer, the surgical approach has been consistent, that is, a right hemicolectomy and a trans-transverse colon anastomosis. For the acute obstruction caused by left colon cancer, it has been advocated in the past that the obstruction should be relieved after the first stage of ostomy or removal of the tumor, and the second stage of the operation should be anastomosis. We performed 11 patients with obstruction caused by left colon cancer and underwent a stage 1 colon resection of the colon anastomosis in the emergency department. Only 1 patient had an anastomotic leakage due to a long period of obstruction, anemia, and hypoproteinemia. The rest 10 All cases recovered well and no postoperative complications occurred.