不同年龄直肠癌患者行腹腔镜与行开腹根治术的比较

Comparison Between Laparoscopic and Open Radical Operation in Patients with Rectal Cancer of Different Ages

目的探讨腹腔镜直肠癌根治术在不同年龄患者中受益程度的差别。方法从2008年1月至2009年3月期间我院对76例患者行直肠癌根治术,大于70岁的老年组34例,其中行腹腔镜根治术16例,开腹根治术18例;小于70岁的中青年组42例,其中行腹腔镜根治术23例,开腹根治术19例。对这2组患者围手术期的各项数据进行回顾性分析,并分别比较2组行腹腔镜与开腹根治术的差异。结果2组均无手术死亡病例;在术后通气、进食及住院时间方面,2组中的腹腔镜根治术患者均明显短于开腹根治术患者(P<0.05,P<0.01);术中出血量及术后镇痛比例也更少(P<0.01);在平均手术时间及淋巴结清扫数目方面两种手术之间差异均无统计学意义(P>0.05)。在中青年组,除切口感染率LR明显低于OR(P<0.05)外,在并发症发生率和术后生活自理比例方面,腹腔镜根治术与开腹根治术患者比较差异均无统计学意义(P>0.05);而在老年组,腹腔镜根治术患者的各项并发症发生率均明显低于开腹根治术患者(P<0.05),而术后生活自理比例则显著增高(P<0.01)。结论腹腔镜下直肠癌根治术可以安全地用于老年及中青年患者。相比较而言,在术后并发症发生率及术后生活质量方面,老年直肠癌患者接受腹腔镜根治术的获益则显得更加明显,腹腔镜根治术对于老年直肠癌患者可能有更好的应用前景。

Objective To evaluate the feasibility of laparoscopic rectal resection（LR） in elderly and younger patients with rectal cancer.Methods From January 2008 to March 2009,76 patients with rectal cancer undergoing elective rectal resection were included in this study.Older than 70 years named elderly group,in which LR was given to 16 cases,and open resection（OR） to 18 cases.Younger than 70 years named younger group,in which LR was performed in 23 cases,and OR in 19 cases.The results after LR and OR in rectal cancer between 2 groups of patients were compared.Results No surgery-assisted death occurred in either group.In 2 groups,ventilation time,intake food time and hospitalization after operation in LR were shorter than those of OR（P0.05,P0.01）;intraoperative blood loss and the proportion of postoperative analgesia in LR were less than those of OR in 2 groups（P0.01）;there were no significant differences between LR and OR（P0.05） in mean operation time or number of lymph node resected.In addition to the incision infection rate,the other complications rates and the postoperative life self-care rate between LR and OR were no significantly different in younger group（P0.05）.In the elderly group,every complication rates of LR were lower than those of OR（P0.05）,oppositely,the postoperative life self-care rate was higher（P0.01）.Conclusions LR of rectal cancer can be applied to both elderly and younger patients.It is suggested that advanced age should not be the contraindication for LR,and by contrary elderly patients may be particularly indicated for lower postoperative complications rate compared to open surgeries.