70岁以上老年患者腹腔镜直肠癌手术安全性的研究

Study on the Safety of Over-70 years Senior Patients Undergoing Laparoscopic Surgery for Their Rectal Carcinoma

为探讨70岁以上老年直肠癌患者行腹腔镜手术的安全性及可行性，回顾分析我院2012年12月至2014年12月收治的156例老年直肠癌患者资料，其中腹腔镜手术48例（腹腔镜组），开腹手术108例（开腹组），对比2组患者的临床结果。结果显示，与开腹组比较，腹腔镜组患者术中出血量减少[（130．7±141．2）mL vs（232．6±290．4）mL]，术后肛门排气时间缩短[（3．1±1．6）d vs（3．9±1．4）d]，术后住院时间缩短[（13．5±6．7）dus（15．3±8．4）d]，术后肺部感染（4．2％vs6．5％）、创口愈合不良（2．1％vs4．6％）、心血管意外（2．1％ vs 3．7％）发生率明显降低，各指标组间比较，差异均有统计学意义，P〈0．05。手术时间、清除淋巴结数目、手术成功率、总体保肛率方面，2组比较差异均无统计学意义，P〉0．05。2组均无手术死亡病例，标本切缘病理学检查均为阴性。结果表明，腹腔镜直肠癌根治术具有微创的优点，对于70岁以上老年直肠癌患者是安全可行的，且术后并发症发生率低，是老年直肠癌患者理想的选择。

In order to explore the safety and feasibility of senior patients（≥70 yr.） undergoing laparoscopic surgery for rectal carcinoma, authors retrospectively analysed the data of 156 cases admitted in author＇s hospital from Dec.2012 to Dec. 2014 yr. among whom 48 underwent laparoscopic surgery（as laparoscope group,simplified L group）, 108 underwent open surgery at abdomen（as open group） ;then compared both groups＇ clinical outcome.As results, compared with open group in intraoperative bleeding volume, postoperative time for flatus of anus, postoperative hospitalization time, postoperative incidence of lung infection, poor rate of wound healing,and incidence of cardiological events,etc L group had more less [（130.7±141. 2） mL vs （232.6±290.4） mL],more shorter [（3.1±1.6） d vs （3.9±1.4） d] more shorter [（13.5±6.7） d vs （15.3±8.4） d],more lower （4.2% vs 6.5%）,more lower（2.1% vs 4.6~）,more lower （2.1%vs 3.7%）, etc. There was all statistical difference through the comparison among various indexes（ P 〈0.05） ; in operation time, the number of removed lymph node, successful rate of operation, and total anus-preserved rate there was no statistical difference （ P〉0.05）;And,in both groups no operative death cases were found, their pathological examination of specimen sections were all negative.Results show that laparoscopic surgery for radical treatment of rectal carcinoma has minimally invasive merit which for senior patients （≥70 yr.） is safe and feasible, and with lower incidence of postoperative complication, thus is ideal choice for senior rectal carcinoma.