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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 investigate the surgical treatment of advanced rectal cancer in the elderly. Methods The clinical data of 65 patients with advanced colorectal cancer admitted from 2000 to 2004 were analyzed retrospectively. The results were DukesD or liver metastases. Hartmann’s operation line in 26 cases, 14 cases of single-sigmoid colonostomy, 16 cases of double-sigmoid colonostomy, resection of liver metastases in 12 cases. Among them, 19 cases received rectal artery catheterization chemotherapy and 15 cases hepatic artery catheterization chemotherapy. The 3-year survival rate of Hartmann’s procedure was 34% (9/26). The mean survival time of hepatic artery catheterized chemotherapy group and rectal arterial catheterized chemotherapy group was (20 ± 3.17) months, with or without hepatic artery The mean survival time of patients with liver metastases and non-surgical treatment of catheterization chemotherapy was (10 ± 1.77) months. There was a significant difference between the two groups (P <0.05). Conclusions Palliative surgery and sigmoidostomy are mainly used to treat advanced rectal cancer. Irresectable primary or hepatic metastases can choose hepatic artery or rectal artery catheter chemotherapy. Hepatic artery catheter chemotherapy, the new chemotherapy drug oxaliplatin, Xeloda use, can improve the resection rate and survival rate of metastases.