【作者】 蔡宏； 朱蕙燕； 王亚农； 吴江宏； 莫善兢；

【Author】 Cai Hong Zhu Hui-Yan Wang Ya-Nong Wu Jiang-Hong Mo Shan-Jing Department of Surgery, Cancer hospital, Fudan University, Shanghai 200032

【机构】 复旦大学附属肿瘤医院腹部外科；

【摘要】 目的:通过对老年人大肠癌发病率、临床病理特点、术前合并症、手术并发症、预后等分析研究,探讨老年人大肠癌的外科诊治。方法:对复旦大学附属肿瘤医院1985年1 月～2003年12月手术治疗的266例年龄≥75岁的老年人大肠癌病例,进行临床和病理资料的回顾性分析。结果:266例老年人大肠癌,占同期手术治疗的大肠癌病例的7．0％。其中男性151例,女性115例,年龄75～91岁,平均78．3岁。病变部位以直肠和乙状结肠多见,占69．1％,但右半结肠癌仍有59例,占22．2％。肿瘤最大直径平均5．3cm(0．8～16． 0cm)。主要临床症状包括:便血173例(65．0％)、便次增多 88例(33．1％)、腹痛62例(23．3％)、黏液便29例(10．9％)、便形变细28例(10．5％)、腹胀28例(10．5％)、腹泻和便秘交替7例(2．6％)等。有94例病例(35．3％)术前存在心血管疾病、糖尿病等合并症,其中存在一种、二种、三种和四种合并症分别有76例(28．6％)、12例(4．5％)、5例(1．9％) 和1例(0．4％)。215例病例(80．8％)行根治性切除术,35 例病例(13．2％)行姑息性切除,1例(0．4％)行捷径术,9 例(3．4％)行造瘘术,6例(2．3％)行单纯手术探查术。术后有30例(11．3％)出现肠梗阻、出血、感染等并发症,其中3例(占1．1％)出现手术后死亡。266例中有多原发大肠癌16例(6．0％),其中同时多原发大肠癌10例,异时多原发大肠癌6例。有10例(3．8％)存在其他器官恶性肿瘤,包括食道癌、胃癌、肺癌等。根据手术探查和病理检查,266例病例中Dukes’A期、B期、C期和D期分别有56例(21．1％)、 78例(29．3％)、91例(34．2％)和41例(15．4％)。51例(19． 2％)为腺瘤癌变病例,其中管状腺瘤、绒毛状腺瘤、混合性腺瘤癌变者分别有9例、27例和15例。本组随访1个月～16 年,中位随访期64个月,总体5年生存率为51．3％。结论:虽然老年人大肠癌患者术前合并症和术后并发症的发生率较高, 但在重视围手术期的检测和处理后手术死亡率并不高,且术后5年生存率仍可达50％以上。因此,在大肠癌发病率日益上升和老年人日益增多的今天,对老年人大肠癌的临床诊治已不容忽视。更多还原

【Abstract】 Objective: Try to analyse the incidence of colorectal cancer (CRC) in the elderly patients, their clinical and pathological characteristics, surgical complications and prognosis, discuss the surgical treatment in the elderly. Methods: 266 CRC patients with their age over 75 years, which were accepted surgical treatment in Cancer Hospital, Fudan University in January 1985 to December 2003, were submitted to a retrospective study. Results: Among the 3778 operated cases of CRC, 266 cases (7.0%) were over 75 years (male 151, female 115). The rectum and sigmoid colon were the most popular sites in these elderly patients, but still there were 59 cases (22. 2%) with their tumors located in the right site of colon. Hemafecia, increase of stool and abdominal pain were the main symptoms. 94 cases (35.3%) had complicated diseases before operation, such as cardiovascular disease and diabetes mellitus. 215 cases (80.8%) were accepted radical excision while 35 cases (13.2%) accepted palliative resection. 30 cases (11.3%) had postoperative complications, such as obstruction, haemorrhage, infection and so on. 3 cases (1.1%) died several days after operation. 16 cases (6.0%) had multiple CRC while 51 (19. 2%) had adenocarcinogenesis characteristics and 10 (3.8%) had extracolorectal malignancies, such as esophageal carcinoma, gastric cancer and bronchogenic carcinoma. The overall 5-year survival of these elderly patients was 51.3%. Conclusion: Though the elderly CRC patients had more complicated diseases before operation and more postoperative complications, the operative mortality is still lower if much more attentions are paid during operation. Also they had good 5-year survival more than 50%. So the surgical treatment shouldn’ t be ignored in the elderly CRC patients today.更多还原