老年人左半结直肠癌致急性肠梗阻的急诊手术治疗探讨

摘要

目的：探讨老年人左半结直肠癌致急性肠梗阻的急诊手术治疗方法及效果。方法回顾性分析2008-01～2012-01郑州人民医院收治的103例左半结直肠癌致急性肠梗阻的病例资料。结果左半结肠癌肠梗阻者71例，行左半结肠根治术一期吻合26例，Hartmann术19例，行结肠造口后二期肿瘤切除术7例，腹腔多发转移行结肠造口19例；直肠癌肠梗阻者32例，行肠梗阻套管减压后行直肠癌Dixon根治术5例， Hartmann术16例，因腹腔广泛转移行乙状结肠双腔造口术11例。术后发生吻合口漏6例，切口感染6例，均经积极非手术治疗痊愈。术后肺炎死亡2例。结论老年人左半结直肠癌致急性肠梗阻治疗的首要目标是解除梗阻及挽救患者生命，应根据患者的情况及医院的医疗条件选择合适的手术方式。%Objective To investigate the effects of surgical managements of acute obstruction caused by pri -mary left colorectal carcinoma in the elderly .Methods Clinical data of 103 patients with acute obstruction caused by primary left colorectal carcinoma , who were treated by emergent operation in the people′s hospital of Zhengzhou from January 2008~January 2012 , were retrospectively analyzed .Results Of 71 patients with left colon carcinoma , 26 received one stage tumor resection and anastomosis , 19 received Hartmann operation , 7 were performed colostomy and then tumor resection , and only 19 patients who had celiac metastasis received colostomy .Of 32 patients with rectal carcinoma received emergency operation , 5 received preoperative stent insertion and Dixon operation , 16 received Hartmann operation , and only 11 patients with celiac metastasis were performed colostomy .As postoperative compli-cations, incision infection occurred in 6 cases and intestinal fistula in 6 cases.Otherwise, 2 patients died for pneu-monia.Conclusion Dissolving those obstructions and saving patients′life was the key for surgical treatment of acute obstruction caused by primary left colorectal carcinoma in the elderly .Surgical treatment should be considered as the first choice , and the selection of appropriate surgical methods should be dependent on the patients ′illnesses and re-gional medical conditions .