80岁以上高龄结直肠癌患者接受腹腔镜辅助根治手术的围手术期安全性观察

A clinical study of laparoscopic colorectal surgery in octogenarians

目的:通过比较高龄结直肠癌患者接受腹腔镜辅助根治性手术与传统开腹根治性手术的围手术期情况,了解腹腔镜辅助结直肠癌根治手术对高龄结直肠癌患者的治疗安全性。方法:2006年1月至2008年6月,69例大于等于80岁的结直肠癌患者接受限期性根治手术,其中26例接受腹腔镜辅助结直肠癌根治术(腹腔镜组),男13例,女13例,平均(83.91±3.02)岁(80～90岁);43例接受传统开腹结直肠癌根治术(开腹组),男29例,女14例,平均(83.70±3.43)岁(80～91岁)。回顾性分析比较两组患者的术前评估(ASA评分)、术前合并症情况、手术病理分级(Dukes分期)、术中及术后血气分析变化、术后胃肠道功能恢复时间、住院天数及并发症等围手术期情况。结果:手术前,两组间的ASA评分无显著差异(Ⅰ级5:8,Ⅱ级19:32,Ⅲ级2:3,P>0.05),伴随的合并症发生率无显著差异(19/26,73.1%vs.26/43,60.5%,P>0.05)。腹腔镜组术中未出现高碳酸血症。术后24h与72h出现血气分析异常,分别为5人及2人,与开腹组的18人和7人相比,有显著性差异(P<0.05);腹腔镜组恢复排气时间显著短于开腹组[(2.27±0.46)dvs.(3.68±0.58)d](P<0.05);术后住院天数显著低于开腹组[(14.55±7.21)dvs.(22.16±18.99)d](P<0.05);术后并发症发生率显著低于开腹组(6/26,23.1%vs.18/43,41.9%,P<0.05);两组手术死亡率方面无显著差异,其中腹腔镜组死亡率3.85%,开腹组手术死亡率4.65%(P>0.05)。结论:80岁以上高龄结直肠癌患者选择腹腔镜辅助根治术比传统开腹手术具有术后康复快、并发症少等优势,同时腹腔镜手术不会增加术后死亡率。因此,腹腔镜辅助结直肠癌根治术对于高龄结直肠癌患者具有良好的手术安全性。

Objective：To evaluate the safety, efficacy and advantages of laparoscopy-assisted colorectal surgery in patients of octogenarians with colorectal cancer. Methods： Operation safety, complications, and postoperative recovery of 26 patients of octogenarians who underwent laparoscopy-assisted colorectal surgery （LAP group） were analyzed retrospectively and compared with those of 43 patients undergoing conventional open surgery （ OP group） between January 2006 to June 2008. Results：No case in LAP group has hypercapnia during operation. 1 death in 26 cases was found in LAP group because of heart failure,while 2 in 43 cases in OP group because of severe pulmonary infection （ 1 case） and heart failure（ 1 case）. There were 6 in 26 cases of complications in LAP group which were significantly less than those in OP group （18 in 43 cases ,P 〈 0.05 ）. Mean time to flatus of the LAP group and hospital stay after operation were （2.27 ±0.46） days and （ 14.55 ±7.21 ） days respectively,which were significantly less than those of OP group （P 〈 0.05 ）. No significant difference was found between LAP group and OP group in terms of mortality （ P 〉 0.05 ）. Conclusions ： Laparoscopy-assisted colorectal surgery was safer and beneficial to the octogenarians.