腹腔镜联合快速康复结直肠外科手术在老年人结直肠癌治疗中的近期疗效分析

Short-term effect of laparoscopy in combination with fast-track colorectal surgery on colorectal cancer in the elderly

目的评估70岁以上老年结直肠癌患者接受腹腔镜联合快速康复结直肠外科（FTCS）治疗的安全性、可行性。方法将123例老年结直肠癌患者，随机分为腹腔镜＋FTCs组（41例）、腹腔镜组（41例）和开腹组（41例）。比较患者手术效果指标，康复指标以及术后并发症等。结果腹腔镜＋FTCS组与单独腔镜组或开腹组比较，其失血量、手术时间、排便时间，淋巴结清扫个数等差异无统计学意义（p〉0．05）；腹腔镜＋FTCS组较腔镜组或开腹组能够显著缩短患者下床时间、排气时间、首次流质时间以及住院时间（P〈0．05）。各组术后并发症发生率分别为腹腔镜十FTC3组：12．2％（5／41）；腹腔镜组：34．1％（14／41）；开腹组：68．3％（28／41）。腹腔镜4-FTCS组患者并发症发生率低于腹腔镜组和开腹组（x2=5．549，P=0．018；x2=28．826，P0．01），腹腔镜组患者并发症发生率显著低于开腹组（x2=9．567，P=0．002）。结论腹腔镜联合FTCS治疗方法在老年结直肠癌治疗中安全有效，是老年结直肠癌患者的理想治疗方式。

Objective To evaluate the safety and feasibility of laparoscopy in combination with fast track coloreetal surgery （FTCS） in the treatment of colorectal cancer in the elderly. Methods A total of 123 patients were randomly divided into 3 groups： the laparoscopy plus FTCS group （n= 41）, the laparoscopy group （n=41） and the laparotomy group （n=41）. Parameters for measuring surgical quality, recovery and postoperative complications were analysed. Results No significant differences were found in age, gender, tumor location, anesthesia ASA classification, American Joint Committee on Cancer （AJCC） Tumor Node Metastasis （TNM） staging, Eastern Cooperative Oncology Group （ECOG） score or complications between the three groups （P〉0.05 for all）. There were no differences in blood loss, operative time, time required to resume defecation or number of lymph nodes dissected between the laparoscopy plus FTCS group and the laparoscopy or laparotomy group （P〉0.05 for all）, but time taken to initiate postoperative ambulation, time taken to resume flatulence, time taken to start intake of liquid food and length of hospital stay were shorter in the laparoscopy plus FTC8 group than in the other groups （P〈0.0,5 for all）. The incidence of postoperative complications was 12.2% or 5/41 in the laparoscopy plus FTCS group, which was lower than in the laparoscopy group （34. 1% or 14/41） and in the laparotomy group （68.3% or 28/41） （x2=5. 549 and 28. 826, P=0. 018 and 0.01, respectively）,a statistically significant difference was also found between the latter two groups （ x2 = 9. 567, P=0. 002 ） . Conclusions Laparoscopy in combination with FTCS is safe and effective in the treatment of colorectal cancer in the elderly.