高龄结肠癌患者接受完整结肠系膜切除术的可行性研究

Feasibility of complete mesocolic excision in elderly patients with colon cancer

目的探讨高龄结肠癌患者接受完整结肠系膜切除术（CME）的短期疗效和安全性。方法回顾性分析北京大学人民医院胃肠外科2009年11月至2012年2月间接受CME治疗的71例结肠癌患者的临床资料，以70岁为界点分为高龄组（大于或等于70岁．37例）和非高龄组（小于70岁，34例），比较两组患者的短期疗效和安全性。结果高龄组与非高龄组结肠癌患者CME手术切除系膜面积分别为（13049±4332）mmz和（13163±4725）mm2，高位结扎血管距肠壁距离为（95±22）mm和（98±20）mm，高位结扎血管距肿瘤距离为（130±25）mm和（128±25）mm，结肠切除长度（262±60）mm和（245±49）mm，淋巴结清扫数目为（22．0±6．4）枚和（24．8±9．9）枚，差异均无统计学意义（均P〉0．05）。两组患者手术时间、术中出血量、术后主要并发症、排气时间、排粪时间、引流管拔除时间、恢复进食时间、术后3d引流量、住院死亡等安全性指标的差异亦无统计学意义（均P〉0．05），但高龄患者住院时间和住院费用明显增加（均P〈0．01）。结论高龄结肠癌患者接受择期CME手术可以达到与非高龄组患者一致的肿瘤切除及淋巴结清扫效果．且手术安全性良好．

Objective To explore the short-term outcomes and safety of complete mesocolic excision （CME） in elderly patients with colon cancer. Methods The clinical pathological factors of 71 patients with colon cancer undergoing CME procedure by the same group of surgeons were analyzed retrospectively from November 2009 to February 2012. The elderly group （≥70 years） and the non- elderly group （〈70 years） were compared regarding short-term outcomes and safety. Results Similar extent of resection could be achieved in the elderly and non-elderly groups in terms of area of mesentery [ （13 049±4332） vs. （13 163±4725） mm2, P=0.916], distance between the tumor and the high ligation site [（95±22） vs. （98±20） mm, P=0.516], distance between normal bowel and high ligation site [（130±25） vs. （128±25） mm, P=0.731], the length of colon [（262±60） vs. （245±49） mm, P=0.2121, and lymph nodes retrieved （22.0±6.4 vs. 24.8±9.9, P=0.168）. The mean operative time, intraoperative blood loss, postoperative complications, time to first flatus, time to first bowel movement, drainage removal time, diet resumption, drainage volume in three days after surgery, and hospital deaths showed no statistical signifieanees （all P〉0.05）, while hospital stay and expenses of the elderly group were significantly increased （both P〈0.01）. Condtmion Elderly patients undergoingelective CME operation （：an achieve similar operative extent and lymph nodes harvest, and the surgieal risk is not inereased.