高龄结直肠癌手术治疗的生存分析

Surgical treatment for colorectal cancer in elderly patients

目的对80岁以上高龄患者结直肠癌的临床与病理特点、手术方式和生存分析进行探讨。方法选择69例80岁以上的高龄结直肠癌患者,对其一般资料、临床表现、肿瘤病理特征、手术方式及术后并发症等进行回顾性分析。结果 45例(65.21%)合并其他疾病,主要为高血压、糖尿病、心血管疾病、肺部疾病、泌尿疾病及脑部疾病,TNMⅢ期28例(40.58%)、Ⅳ期17例(24.64%)。手术方式以根治性手术为主(67例),根治率达97.10%。术后1年、2年、3年的生存率分别为89.86%、69.57%、62.32%。生存分析显示肿瘤分期、手术根治性是影响生存率的主要因素,而单纯年龄因素对生存率没有显著影响。结论老年结直肠癌术前合并症相对多见,但肿瘤病理分化程度较高,恶性程度相对较低。高龄不是限制其手术治疗的主要因素,术前进行准确的分期评估、积极治疗合并疾病、加强围手术期监护、提高手术根治率以及加强术后护理,均有助于提高老年结直肠癌患者生存率和生活质量。

Objective To analyze the clinical and pathological characteristics of colorectal cancer among elderly patients. Methods Sixty nine patients aged over 80 years （range 80 - 93 ） with colorectal cancer receiving surgical treatment in Shanghai Dongfang Hospital from Jun 2012 to May 2013 were included for analysis. Among 69 patients, 39 were males and 30 females; 46 cases were colon cancer and 23 were rectal cancer, all diagnosis was confirmed by operation and pathology. The symptoms, preoperative complications, histological type, surgical approach, postoperative complications were retrospectively analyzed. Results The initial symptoms were non-specific for elderly patients with colorectal cancer. Hypertension, diabetes, heart disease, pulmonary disease, urologic disease and cerebral disease were coexisted in 45 cases （65.21%）. TNM stage Ⅲ was in 28 cases （40.58%） and stage Ⅳ was in 17 cases （24.64%）. Tubular adenocarcinoma was the major pathological type （42 cases, 60. 87% ） , followed by moderately differentiated adenocarcinoma （17 cases, 24.65% ）.Radical operations were performed in 67 cases （97. 10% ）. Postoperative complications were pulmonary infection （3 cases）, upper respiratory tract infection （1 case）, urinary tract infection （1 case） and water-electrolyte imbalance （1 case）. The 1-year, 2-year and 3-year survival rates were 89.86%, 69.57% and 62.32%, respectively. The survival analysis shows that tumor TNM stage and operational modality were associated with survival rate, while age did not affect the survival of patients. Conclusion The early diagnostic rate of colorectal cancer among these people is relatively low. The pathological types among the elderly are relatively highly differentiated and less aggressive. Age is not the limitation of surgical treatment. A full consideration should be given to the general conditions and coexisting diseases in order to select a suitable surgical procedure and make a detailed treatment plan during the preoperative, intraoperative and postoperative periods to prolong life span for the elderly patients.