腹腔镜内镜微创手术治疗 高龄结直肠癌患者

Laparoscopic and endoscopic minimally invasive surgery for the elderly patients with colorectal carcinoma

目的探讨腹腔镜内镜微创手术治疗高龄结直肠癌患者的安全性、可行性以及围手术处理。方法回顾性分析我院2010年10月～2012年12月间153例采用择期腹腔镜内镜微创手术治疗的70岁以上高龄结直肠癌患者的临床资料。采用一套专门制定的诊治流程进行围手术期处理,并运用个体化的微创手术进行治疗,其中腹腔镜辅助结直肠手术148例、经肛门内镜微创手术5例。结果本组153例均按预期完成腹腔镜或内镜微创结直肠手术,无手术死亡,手术时间平均170 min,出血量平均185 ml,术后住院时间平均8.3 d。术后并发心功能不全、肺部感染、伤口并发症和尿潴留的比例分别仅为1.3%、3.9%、3.3%和7.8%。结论高龄患者因各种并存病增加了手术风险,围手术期应多科协作,有针对性地进行处理。腹腔镜内镜微创手术治疗高龄结直肠癌患者是安全、可行的。

Objective To investigate the safety, feasibility and perioperative management of laparoscopic and endoscopic minimally invasive surgery for the elderly patients with colorectal carcinoma. Methods One hundred and fifty-three over 70 years-old patients undergoing selective laparoscopic and endoscopic minimally invasive surgery in our hospital from October 2010 to December 2012 were analyzed retrospectively. A diagnosis and treatment process was specially formulated for the perioperative management. And individual minimally invasive operations were performed to treat patients. There were laparoscopic-assisted operation in 148 and transanal endoscopic microsurgery in 5. Results All the 153 patients underwent laparoscopic or endoscopic minimally invasive colorectal surgery according to the expected. There was no operation-related mortality. The median operating time, blood loss and postoperative hospital stay were 170 minutes, 185 ml and 8.3 days, respectively. The occurrence rates of postoperative cardiac dysfunction, pneumonia, wound complications and urinary retention were only 1.3%, 3.9%, 3.3% and 7.8%, respectively. Conclusion Various comorbidities increase the operation risk of elderly patients, so multidisciplinary collaboration and effectively management shall be performed during perioperative period. It＇s safe and feasible of laparoscopic and endoscopic minimally invasive surgery for the treatment of elderly patients with colorectal carcinoma.