老年人结直肠肿瘤的微创手术治疗

Laparoscopic colorectal surgery for elder patients with colorectal tumor

目的探讨腹腔镜结直肠手术治疗70岁以上老年人结直肠肿瘤的安全性与有效性。方法回顾性总结2003年1～10月腹腔镜辅助与开腹结直肠手术治疗70岁以上老年人结直肠肿瘤的经验。同期比较腹腔镜手术(LAP组)30例与传统开腹手术(OPEN组)71例的手术安全性、并发症、术后恢复情况。结果LAP组无手术相关死亡病例,OPEN组有2例(2.8%)分别因为术后肺部感染与吻合口瘘而死亡。两组病人随年龄增加ASA(americansocietyofanesthesiologyscore)分级增高。OPEN组有29例(40.8%)发生术后并发症显著多于LAP组6例(20.0%)(P<0.05)。LAP组病人术中出血、排气时间与进食半流质时间分别为(91.7±49.9)mL、(2.3±1.2)d与(4.9±1.8)d,与OPEN组(156.3±118.8)mL、(3.4±2.9)d与(5.8±1.2)d相比差异有显著性意义(P<0.05)。两组手术时间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岁以上老年人结直肠肿瘤安全有效,值得进一步推广应用。

Objective To evaluate the safety, efficacy and advantages of laparoscopic colorectal surgery for the eider patients with colorectal tumor. Methods Opration safety, complications, and postoperative recovery of 30 patients older than age 70 who underwent laparoscopic colorectal surgery（ LAP group） were analyzed retrospectively and compared with those of 71 elder patients performed conventional open surgery（ OPEN group） between January 2003 and October 2003. Results No surgery-related death occurred in LAP group and 2 death were found in OPEN group because of pulmonary infection and anastomotic leak respectively. There were 29 （40. 8% ） cases of complications in the OPEN group which was significantly more than those of LAP group. Oprative risk, termed of ASA class （American Society of Anesthesiology score）, increased with the increase of patients＇ age. Mean hood loss,flatus and time to normal diet of LAP group were 91.7±49. 9 ml,2.3 ± 1.2 days, and 4. 9 ± 1.8 days respectively,which was significantly less than those of OPEN group（ P 〈0. 05）. Mean operative times and hospital stay were comparable between the two groups （ P 〉 0. 05 ）. Conclusion Laparoseopic colorectal surgery is safe and beneficial to the patients older than age 70 and it should be adopted widely.