老年人晚期直肠癌65例外科治疗体会  

Surgical Treatment of Advanced Rectal Carcinoma in Aged People

作　　者：杨少华[1] 陈少逸[1] 文军[1] 郭国湖[1] 林李波[1] 何新卫[1] 

机构地区：[1]汕头大学医学院第二附属医院普外科,广东汕头515041

出　　处：《中国医师杂志》2005年第4期502-504,共3页Journal of Chinese Physician

摘　　要：目的探讨老年人晚期直肠癌的外科治疗方法。方法回顾性分析2000～2004年收治的65例晚期直肠癌的临床资料。结果均为DukesD期或肝转移病例。行Hartmann’s术式26例,单腔乙状结肠造口术14例,双腔乙状结肠造口16例,肝转移癌切除12例。其中直肠上动脉置管化疗19例,肝动脉置管化疗15例。行Hartmann’s术式者3年生存率为34%(9/26),肝动脉置管化疗组和直肠上动脉置管化疗组平均生存期为(20±3.17)月,未切除或未行肝动脉置管化疗的肝转移癌及非手术治疗组平均生存期(10±1.77)月。两组具显著性差异(P<0.05)。结论姑息性手术和乙状结肠造口术主要用于治疗晚期直肠癌。不能切除的原发灶或肝转移灶可选择肝动脉或直肠上动脉置管化疗。肝动脉置管化疗,新化疗药草酸铂、希罗达的使用,可以提高转移癌切除率及生存率。Objective To explore the surgical treatment of advanced rectal carcinoma in aged people. Methods The clinical data of 65 aged patients with advanced rectal carcinoma from 2000 to 2004 were analyzed retrospectively. Results All cases were Dukes D stage or accompanied with hepatic metastasis. Hartmann's operation was performed in 26 cases, single lumen sigmoidostomy in 11 cases, double lumen sigmoidostomy in 11 cases and resection of hepatic metastatic cancer in 12 cases. Rectal upper arterial catheter chemotherapy was performed in 19 cases and hepatic arterial catheter chemotherapy in 15 cases. The 3-year survival rate of Hartmann's operation was 34%(9/26), and the average survival time was 20±3.17 months in the patients underwent rectal upper and hepatic arterial catheter chemotherapy, and 10±1.77 months in the patients who could not be treated surgically(P<0.05). Conclusion Palliative resection and sigmoidostomy are main methods for treating advanced rectal carcinoma. Arterial catheter chemotherapy can be performed in cases, whose primary or secondary lesions are unresectable. Hepatic arterial catheter chemotherapy using new medicines such as oxaliplatin, xeloda could increase the resection rate of metastasis and improve survival rate.

关 键 词：晚期直肠癌 老年人 肝动脉置管化疗 治疗体 单腔乙状结肠造口术 平均生存期 外科治疗方法 2004年 回顾性分析 DUKES 3年生存率 显著性差异 姑息性手术 临床资料 肝转移癌 肝转移灶 不能切除 癌切除 治疗组 非手术 未切除 

分 类 号：R735.3[医药卫生—肿瘤]