目的　探讨结直肠癌并发急性穿孔的临床特点及其诊断和治疗。方法　回顾性分析 19年间本院收治的 3 8例结直肠癌并发急性穿孔的临床资料。结果　本病多见于老年人 (平均年龄 62岁 ) ,原发病灶多位于左半结肠和直肠上段 (2 7/3 8,71.1% ) ,肿瘤近侧结肠及盲肠穿孔占 81 6% (3 1/3 8) ,肿瘤部位穿孔占 18 4% (7/3 8) ,术前正确诊断率仅 15 8% (6/3 8) ,术后并发症多而严重 ,围手术期死亡率为 42 1% (16/3 8) ,死亡原因均为多器官功能衰竭 ,手术早晚与围手术期死亡率有密切关系。术后复发率为41 2 % (7/17) ,5年生存率为 2 3 5 % (4 /17)。结论　及时诊断、早期手术和防治多器官功能衰竭是降低本病死亡率的关键。 Objective To investigate the clinical characteristics of colorectal cancer complicated with acute perforation and its diagnosis and treatment. Methods The clinical data of 38 patients with colorectal carcinoma complicated with acute perforation admitted to our hospital during 19 years were retrospectively analyzed. Results The disease was more common in the elderly (mean age 62 years). The primary lesions were mostly located in the upper left colon and rectum (27/3 8 and 71.1%). The tumors and cecum perforation accounted for 81.6% (31 / 38). The perforation of the tumor site was 18 4% (7/3 8). The correct preoperative diagnosis rate was only 15 8% (6/3 8). The postoperative complications were severe and severe. The perioperative mortality rate was 42 1% (16/3 8). The causes of death were multiple organ failure. The rate of perioperative mortality was closely related to the rate of operation. The recurrence rate was 41 2% (7/17) and 5-year survival rate was 23 5% (4/17). Conclusions Timely diagnosis, early surgery and prevention and treatment of multiple organ failure are the keys to reduce the mortality of this disease.