Pavlidis T E, Marakis G, Ballas K, Rafailidis S, Psarras K, Pissas D, Papanicolaou K, Sakantamis A
Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 54642 Thessaloniki, Greece.
Colorectal Dis. 2006 Oct;8(8):657-62. doi: 10.1111/j.1463-1318.2006.00993.x.
Colorectal emergency requiring radical surgery is becoming increasingly frequent in the elderly and problems remain as regards the best management policy. Our long-time experience is presented in this study.
In the last 23 years, 105 elderly patients, aged > or = 65 years, with colorectal disease underwent an emergency operation in our Surgical Department. Forty-five patients (mean age 72 years) had benign disease and 60 patients (mean age 76.5 years) colorectal carcinoma.
The carcinoma was located in the left colon (68%), right colon (18%) and rectum (14%). Mostly, patients with malignant cancer presented with obstructive ileus, and patients with benign tumours with perforation and peritonitis, with a predominance of diverticulitis. A resection operation either with primary anastomosis or Hartmann's procedure was performed in 75% of cases; in the rest, only palliation was resorted to. Forty-three percent of the patients with colorectal cancer emergency were > or = 80 years of age. The mean morbidity was 25% and mortality 17%, which make up to 33% and 26.6% for benign disease, and 20% and 10% for malignant cancer, respectively. The mortality rate was higher in patients with perforation than those with obstruction.
Advanced age is not a contraindication to radical surgery in case of colorectal emergency in the elderly. In the majority, a resection operation is feasible. In high-risk patients, colostomy is a life-saving alternative.
需要进行根治性手术的结直肠急症在老年人中越来越常见，而关于最佳治疗策略仍存在问题。本研究展示了我们的长期经验。
在过去23年中，105例年龄≥65岁的患有结直肠疾病的老年患者在我们外科接受了急诊手术。45例患者（平均年龄72岁）患有良性疾病，60例患者（平均年龄76.5岁）患有结直肠癌。
癌肿位于左半结肠（68%）、右半结肠（18%）和直肠（14%）。大多数患有恶性肿瘤的患者表现为肠梗阻，患有良性肿瘤的患者表现为穿孔和腹膜炎，以憩室炎为主。75%的病例进行了一期吻合或Hartmann手术的切除手术；其余病例仅采取了姑息治疗。43%的结直肠癌急症患者年龄≥80岁。平均发病率为25%，死亡率为17%，良性疾病分别为33%和26.6%，恶性肿瘤分别为20%和10%。穿孔患者的死亡率高于梗阻患者。
高龄并非老年结直肠急症患者进行根治性手术的禁忌证。大多数情况下，切除手术是可行的。对于高危患者，结肠造口术是一种挽救生命的选择。
