腹腔镜结直肠癌根治术在老年患者中的应用探讨

Safety and efficacy of laparoscopic treatment of colorectal cancer for elderly patients

关键词:  腹腔镜手术  结直肠肿瘤  老年

Key words:  laparoscopic surgery  colorectal cancer  elder

摘要:

目的　评价腹腔镜结直肠癌根治术在70岁以上老年患者中应用的安全性和有效性。方法　回顾分析2012年12月至2015年12月86例腹腔镜结直肠癌手术患者的临床资料。分为老年组（≥70岁）38例和对照组（<70岁）48例。老年组与对照组比较，术前合并症（81.6% vs. 56.2%）和ASA I、ASAIII评分有明显差异。积极处理合并症后行腹腔镜手术，比较两组患者的术中及术后恢复情况、并发症发生况等。 结果　两组均无围手术期死亡病例，各有1例中转开腹。两组在手术时间、术中出血量、手术清扫淋巴结数量、肠功能恢复时间、进食流质时间、术后首次下床活动时间及术后住院时间等方面差异均无统计学意义，P>0.05。术后并发症的差异亦无统计学意义(23.7% vs. 14.6%,P=0.283)。结论　老年患者实施腹腔镜结直肠根治性切除术是安全可行的，高龄不是择期腹腔镜结直肠癌手术的禁忌。

Abstract:

Objective　To evaluate the safety and validity of laparoscopic colorectal surgery for patients aged ≥70 years. 　Methods　 This was a retrospective analysis of all patients who underwent laparoscopic colorectal surgery in Yizheng City People's Hospital，Nanjing Medical University Teaching Hospital between Dec.2012 and Dec. 2015. A total of 86 cases were divided into the elderly (aged≥70 years, n=38) and relatively younger groups (aged<70 years, n=48).In the elderly group, patients with American Society of Anesthesiologists（ASA）I score (P=0.024) was significantly lower, ASA III score (P=0.020) and medical comorbidity rate (81.6% vs. 56.2%,P<0.001) were significantly higher than those in the relatively younger group. Demography,surgical procedure, operation indicators, clinicopathological data and short-term outcomes after laparoscopic surgery for colorectal cancer were compared between the two groups.Results　There were no death cases during perioperative period, and one switched to laparotomy in each group. In the postoperative course, there were no significant differences regarding short-term postoperative outcomes including that for timing of first bowel movement, oral diet tolerance, first bowel movement, ambulation after surgery, postoperative hospital stay, and incidence of postoperative complications (23.7% vs.14.6%,P=0.283), respectively.Conclusions　Laparoscopic colorectal surgery (LCS) in elderly patients was safe and feasible in comparison with the relatively younger patients. Age is not a contraindication or limitation for elective LCS.