75岁以上老年患者腹腔镜结直肠癌手术安全性的研究

Safety of laparoscopic colorectal surgery for elderly patients aged over 75 years

目的探讨75岁以上老年结直肠癌患者行腹腔镜手术的安全性、可行性。方法回顾总结我院2005年12月至2010年12月收治行腹腔镜手术与传统开腹手术的75岁以上老年结直肠癌患者的临床资料,比较同期73例腹腔镜手术(腹腔镜组)与71例开腹手术(开腹组)患者的一般情况、疾病分类、ASA(手术危险程度)分级、术中指标、术后恢复、术后并发症。结果腹腔镜与开腹手术组病例在年龄、性别、疾病分类、术前合并症、ASA(手术危险程度)分级上均无显著性差异。腹腔镜组、开腹组手术时间分别为(185.20±40.12)min、(190.50±45.35)min,差异无统计学意义(P>0.05)。腹腔镜组、开腹组术中出血量分别为(105.36±50.28)ml、(210.42±90.51)ml,术后肛门排气时间分别为(3.15±1.65)d、(5.48±2.46)d,进食流质时间分别为(4.38±2.19)d、(6.13±1.98)d,住院时间分别为(9.45±1.24)d、(14.57±3.86)d,差异有统计学意义(P<0.05)。腹腔镜组、开腹手术组无手术相关死亡,并发症发生率分别为23.9%(17/73)和43.2%(32/71)(P<0.01)。结论腹腔镜结直肠癌手术具有微创的优点,对于75岁以上老年结直肠癌患者安全、可行,并发症发生率低,是治疗老年人结直肠肿瘤较好的选择方法。

Objective To evaluate the safety and feasibility of laparoscopic colorectal surgery for elderly colorectal cancer patients aged over 75 years.Methods Clinical data of 73 elderly colorectal cancer patients undergoing laparoscopic colorectal surgery(laparoscopic group) and 71 such patients undergoing conventional open surgery(open group) from December 2005 to December 2010 were analyzed retrospectively.Demographic,pre-operative coexistent diseases and ASA grade,intra-operative blood loss and operating time,post-operative recovery and complications were compared between the two groups.Results No significant differences in age,sex,pre-operative coexistent diseases and ASA grade were found between the two groups.The operating times were(185.20±40.12)min and(190.50±45.35)min respectively in laparoscopic and open groups(P>0.05).The volumes of blood loss were(105.36±50.28)ml and(210.42±90.51)ml,times to recovery of bowel function(3.15±1.65)d and(5.48±2.46)d,times to taking in liquid food(4.38±2.19)d and(6.13±1.98)d,hospital stays(9.45±1.24)d and(14.57±3.86)d,respectively in laparoscopic and open groups(P<0.05).No operation-related death occurred in both groups.The post-operative complication rate was 23.9%(17/73) in laparoscopic group and 43.2%(32/71) in open group(P<0.01).Conclusions Laparoscopic colorectal surgery is safe and feasible,and appears to be a better surgical choice for elderly patients aged over 75 years because of its minimally-invasive advantage and less postoperative complications.