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5年来我科共行大肠癌手术890例,其中高龄患者76例,占8.5%。年龄70~88岁,80岁以上6例。部位:直肠癌47例,结肠痛29例。组织学类型中,腺癌及腺瘤恶变占80%(61/76),Dukes分期以B、C期为多,分别为26例及41例,术前并存病者高达88%(67/76)。术后并发症发生率为21%(16/76)。讨论:高龄大肠癌特点为病程长、就诊晚,肿瘤恶性程度较高,患者体质差,并存病多,术后并发症发生率高。术前应全面详细检查,认真做好术前准备,术中详细探查,无转移及可耐受手术者应行根治术。术后应严密观察,行心电、血压、血氧、中心静脉压等监测。为防止肺部感染,应缩短胃管留置时间,常规给予雾化吸入。行静脉高营养,加强抗感染。术后适时下床活动,但须注意防止心脑血管意外的发生。
In the past five years, our department has performed 890 colorectal cancer surgeries, including 76 elderly patients, accounting for 8.5%. Age 70 to 88 years old, 6 cases above 80 years old. Site: 47 cases of rectal cancer, 29 cases of colon pain. In the histological type, adenocarcinomas and adenomas accounted for 80% (61/76) of malignant tumors. Dukes staged more B and C stages, 26 cases and 41 cases respectively. Preoperative comorbidity was as high as 88% (67/76). ). The postoperative complication rate was 21% (16/76). Discussion: The characteristics of advanced colorectal cancer are long duration of illness, late treatment, high degree of malignancy of the tumor, poor physical fitness, multiple coexistent diseases, and high incidence of postoperative complications. Preoperative examination should be carried out in full detail, preoperative preparation should be done carefully, and detailed exploration should be performed during the operation. No metastasis and tolerable surgery should be performed. Postoperative should be closely observed, line ECG, blood pressure, blood oxygen, central venous pressure and other monitoring. In order to prevent lung infections, gastric tube indwelling time should be shortened, and conventional inhalation should be given. Intravenous hypertrophy strengthens anti-infection. After getting out of bed in a timely manner, care must be taken to prevent the occurrence of cardiovascular and cerebrovascular accidents.