老年患者经腹腔镜与开腹直肠癌根治术的比较

Comparision of laparoscopic and conventional open surgery in elder patients with rectal cancer

目的:探讨腹腔镜手术治疗70岁以上老年人直肠肿瘤的可行性与有效性。方法:回顾总结腹腔镜辅助与开放直肠癌根治术治疗70岁以上老年患者直肠肿瘤的经验。比较同期21例腹腔镜手术(腹腔镜组)与26例开放手术(开腹组)的安全性、并发症以及术后恢复情况。结果:两组均无手术死亡。开腹组术后并发症发生率(42.3%)显著高于腹腔镜组(14.3%)(P<0.05)。腹腔镜组患者术后肠道通气时间与进食时间分别为(2.9±0.5)d、(3.5±0.3)d,与开腹组(4.2±0.7)d、(5.1±0.6)d相比差异有显著性(P<0.05)。两组手术时间、术中出血与住院天数差异无统计学意义(P>0.05)。结论:腹腔镜结直肠手术治疗70岁以上老年人直肠肿瘤安全有效,对于老年直肠癌患者有良好的应用前景。

Objective： To evaluate the safety, efficacy and advantages of laparoscopic colorectal surgery for the elder patients with rectal tumor. Methods： Opration safety, complications, and postoperative recovery of 21 elder patients who underwent laparoscopic colorectal surgery （LAP group） were analyzed retrospectively and compared with those of 26 elder patients performed coventional laparotomy surgery （OPEN group）. Results： No surgery-related death occurred in both and OPEN group. The LAP group had a 14.3% complication rate versus 40.8% in the OPEN group （P 〈 0.05）. Postoperative ileus and time of resumption of food in LAP group were （2.9±0.5） days, （3.5±0.3） days, respectively, which were significantly less than those of OPEN group （4.2±0.7） days and （5.1±0.6） days （P 〈 0.05）. Mean estimated blood loss, operative during and length of hospitalization were comparable between the two groups （P 〉 0.05）. Conclusions： The patients in laparoscopic group had significantly fewer complications, less narcotic use, faster return of bowel function, and were more independent at time of discharge. Laparoscopic surgery is safe procedure to the elderly patients with rectum cancer.