Perioperative Treatment Of The Elder Patients With Rectal Carcinoma

Objective: To assess the perioperative management of rectalcarcinoma in the elder patients over 70 years of age, to analyze theclinical character, accompanied diseases, choice of anesthesia ,reatment of complication, to summarize the experience, to bring upthe level of diagnosis and treatment. Method: The clinical date of surgical treatment for rectalcarcinoma in 104 cases of over 70 years old from 2000 to 2005 wereanalyzed retrospectively. Results: 1.The clinical character of elder people with rectalcarcinoma: (1) The proption of male and female is 1.6 to 1;theaverage age is 74 years old;the pathology type is mostly high andmoddle differentiation adenocarcinoma;the clinical stage is mostlyprogression . (2)There are 65 cases with the accompanied diseasesbefore operation (62.5%), 36 cases(34.6%) with two diseases andmore. 2.The age effect the risk of operation: the complicationincidence rate is 57.1% in over 75 years old team, but 29.3% in theteam age from 70 to 75, the complication in the team younger isobviously lower than the elder(P<0.05) . 3. The effect ofaccompanied diseases:(1) There are 46 cases (70.8%) have thecomplication in the team with accompanied diseases, 15 cases(38.5%)in the normal team, the accompanied diseases team isobviously higher than the normal team(P<0.05).(2) There are 62cases with hypertension, coronary heart disease and changement inthe cardiogram before operation, after operation the circulationsystem complication incidence rate is 16.1%,the 42 cases normalpatients is 4.8%, the circulation system complication in thecirculation system accompanied diseases team is higher than thenormal team(P<0.05).(3) The respiratory tract infection rate inrespiratory system disease team is 80.0%, the team withoutrespiratory system disease is 8.5%, respiratory system disease teamis higher than without respiratory system disease(P<0.05).(4)Complication incidence in the cacotrophia team is 77.8%, only51.9% in the normal nutrition team , the nutrition estate affect thecomplication(P<0.05). 4. Compare the different anesthesia: (1) Thecomplication of Miles team to Dixon team: Miles team is 71.4%,ishigher than Dixon team, s 46.0%( P<0.05);(2) Compare the time ofMiles team and palliating colon stoma team: the time of palliatingcolon stoma team is 140.5±54.2 min, the time of Miles team is206.0±59.7 min, the time of palliating colon stoma team is the timeof Miles team(P<0.05);(3) The relationship between ileus and fistulain Dixon: the fistula incidence rate in the ileus team is 42.9%, ishigher than the normal team, s 5.4% (P<0.05).Conclusions: 1. The proption of male and female is 1.6 to 1 inthe elder rectal carcinoma;the mean age is 74years old, thepathology type is mostly high and moddle differentiationadenocarcinoma. 2. Age is a factor to increase the risk of rinealresection and complication. 3. The accompanied diseases canincrease the complication incidence rate obviously. 4. According toelder carcinoma patient, s characteristic, follow the principle ofreduce wound, shorten time and individual treatment;choose theanesthesia in reason, deduce the risk of operation and complication,improve the patient, s living quality.