老年梗阻性结肠癌围术期处理.DOCVIP

临床医学论文-老年梗阻性结肠癌围术期处理 【摘要】? 目的 探讨老年梗阻性结肠癌的诊断和治疗方法。方法 回顾性分析43例梗阻性结肠癌的诊断和围术期治疗情况。结果 43例患者均行手术，其中15例合并有糖尿病。右半结肠Ⅰ期切除11例,扩大右半结肠Ⅰ期切除术2例,左半结肠Ⅰ期根治性切除5例;Ⅰ期切除、近端结肠造口术20例;捷径手术或单纯肠造口术5例。术后并发症10例（23.25%），死亡1例，病死率为2.33%。结论 老年肠梗阻应考虑到结肠癌的可能，一经诊断应积极术前准备后急诊手术。右半结肠癌合并急性肠梗阻患者，除非患者不能耐受根治术或肿瘤无法切除,均应施以右半结肠切除术;左半结肠癌合并急性肠梗阻如有Ⅰ期手术适应证,均应行Ⅰ期根治手术为妥。合并糖尿病者空腹血糖应迅速控制在10 mmol/L以下。 【关键词】? 结肠癌 肠梗阻 老年人 手术期间 ??? ［Abstract］? Objective? To discuss the method of diagnosis and treatment for colonic obstruction caused by colonic carcinoma.Methods? The diagnosis and treatment of 43 cases of patients with colonic obstruction caused by colonic carcinoma were analyzed retrospectively.Results? Among 43 cases,13 cases complicated with diabetes mellitus（DM）.11 cases underwent colectomy on the right half,two cases performed extended colectomy,5 cases underwent colectomy on the left half on one stage,20 cases underwent colectomy on the left half on one stage,5 cases experienced simple colestomy or bypass,postoperative complications were found in 10 cases(23.25%),of which 1 case died during perioperative period(mortality rate 2.33%).Conclusion?The emergent operation should be done by active preoperative preparations.All colonic obstruction caused by right half colonic carcinoma should be performed with radical resection.All left half should be performed with radical resection also,if they have indications.The blood glucose level of patients complicated with DM should be quickly controlled under 10 mmol/L. 牋?［Key words］? colonic carcinoma；colonic obstruction;aged;intraoperative period ??? 大肠癌伴肠梗阻尤其是左半结肠癌伴肠梗阻的诊断和治疗成了近年临床医生关注的热点。在老年患者中癌性梗阻合并糖尿病较为常见，如何处理好两者之间的关系，提高手术的安全性有着重大意义。现就我院和苏州大学附一医院2006年10月～2007年10月收治的43例梗阻性结肠癌诊断与治疗加以分析。 ??? 1? 临床资料 ??? 1.1? 一般资料? 本组患者共43例，男26例,女17例,年龄60～83岁,平均68.0岁。依照世界卫生组织诊断标准合并糖尿病15例，其中癌肿之前发现糖尿病6例；9例为术前检查发现。肿瘤位于右半结肠13例,其中盲肠6例,升结肠2例,结肠肝曲3例，横结肠2例;左半结肠30例,其中结肠脾曲5例,降结肠8例,乙状结肠17例。病史 2～80天。全组均为单纯急性结肠梗阻,无坏死、穿孔及弥漫性腹膜炎征象。不完全性肠梗阻 31例,完全性肠梗阻12例。本组病例均有腹痛、腹胀、肛门停止排气,或兼有恶心、呕吐等急性肠梗阻症状。其中，15例因保守治疗无效从院外转入，13