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目的探讨老年人结直肠癌合并穿孔的诊断方法、术式选择及疗效,进一步提高诊疗水平。方法回顾性分析34例老年人结直肠癌合并穿孔患者的诊治资料。结果本组患者均做相应的辅助检查,术前明确诊断11例(32.4%)。行结直肠癌根治性切除Ⅰ期肠吻合术14例;结肠癌Ⅰ期根治切除,Hartmann造口术8例;左结直肠癌根治切除Ⅰ期肠吻合+横结肠造瘘术4例;姑息性结直肠癌切除术4例;结肠癌切除+近端结肠造瘘术3例;单纯穿孔修补+近端结肠造瘘术1例。围术期死亡5例(14.7%),29例治愈或好转。结论感染性休克是老年人结直肠癌合并穿孔死亡的主要原因,有重点的采集病史、体格检查和辅助检查可提高早期临床确诊率,及时手术、选择合理的手术方式可减少死亡率、提高生活质量和生存期。
Objective To investigate the diagnosis, collation and efficacy of colorectal cancer complicated with perforation in the elderly to further improve the diagnosis and treatment. Methods The clinical data of 34 elderly patients with colorectal cancer complicated with perforation were retrospectively analyzed. Results The patients were done the appropriate auxiliary examination, a clear preoperative diagnosis in 11 cases (32.4%). The patients underwent radical resection of colorectal cancer with stage I intestine anastomosis in 14 cases, stage Ⅰ colon cancer with radical resection and Hartmann otomy in 8 cases, radical resection of left colorectal carcinoma with stage Ⅰ intestine and transverse colostomy in 4 cases, palliative knot 4 cases of rectal cancer resection; colon resection + proximal colostomy in 3 cases; simple perforation repair + proximal colostomy in 1 case. Perioperative death in 5 cases (14.7%), 29 cases of cure or improvement. Conclusions Septic shock is the main cause of colorectal cancer death associated with perforation in elderly patients. There is a focus on collecting medical history. Physical examination and auxiliary examination can improve early clinical diagnosis and timely operation. Choosing a reasonable surgical procedure can reduce mortality and improve life Quality and survival.