腹腔镜手术治疗老年结直肠癌患者的安全性

Safety of laparoscopic treatment of colorectal cancer for elderly patients

目的:评价腹腔镜手术治疗老年结直肠癌患者的安全性。方法:回顾性分析我院年2003年6月至2013年6月收治的903例行腹腔镜与开腹手术的老年结直肠癌患者的临床资料,比较两组的手术学指标、术后恢复及肿瘤学指标。结果:两组患者的临床病理资料及常见慢性合并症构成比较,差异无统计学意义。腹腔镜组与开腹组比较,患者手术时间[(268.3±105)min vs.(201.5±81.0)min]、术中出血量[(130.8±142.2)m L vs.(232.5±292.4)m L]、术后肠功能恢复时间为[(3.2±1.6)d vs.(3.8±1.4)d]、进食流质时间(4.4±1.6)d vs.(4.9±1.5)d]、术后住院时间[(13.4±6.8)d vs.(15.4±8.5)d]、术中主要并发症发生率[2.0%vs.3.4%]、术后主要并发症发生率[18.0%vs.25.2%]比较,差异均具有统计学意义(均P<0.05)。肺部感染、切口愈合不良和心血管意外发生率腹腔镜组显著低于开腹组(P<0.05)。在切除标本长度、清扫淋巴结数量方面两组比较差异无统计学意义(P>0.05),所有标本切缘病理学检查均为阴性。结论:只要做好充分的术前准备,掌握好手术时机,在熟练掌握腹腔镜结直肠癌手术技术的基础上,对老年结直肠癌患者实施腹腔镜手术是安全可行的。

Objective To evaluate the safety of laparoscopic treatment of colorectal cancer for elderly patients. Methods A retrospective design was used in the present study. From June 2003 to June 2013, a comparison was performed among 903 （1 805） elderly patients with colorectal cancer undergoing laparoscopic or open surgery for their clinical data, postoperative recovery indicators and oncologic outcomes. Results The clinicopathological results and chronic comorbidities had no significant difference between laparoscopie surgery group and open surgery group. There were significant differences between the two groups in terms of operative time [（268.3 ± 105） min vs. （201.5 ± 81.0） mini, blood loss [（130.8 ± 142.2） mL vs. （232.5 ± 292.4） mL], time to recovery of bowel function [（3.2± 1.6） d vs. （3.8± 1.4） d], time to liquid time [（4.4 ± 1.6） d vs. （4.9 ± 1.5） d], postoperative hospital stay [（13.4 ± 6.8） d vs. （15.4 ± 8.5） d], intraoperative complication rate （2.0% vs. 3.6%）, and main postoperative complication rate （18.0% vs. 25.2%）. The rates of lung infections, poor wound healing and cardiovascular accident in laparoscopic group were significantly lower than those in open surgery group （P 〈 0.05）. The length of resected specimen and number of lymph nodes were not significantly different between the two groups and all specimens＇ margins were not involved. Conclusion Laparoscopic surgery for elderly patients with colorectal cancer seems to be safe and feasible provided that preoperative preparation and surgical indications were fully considered.