腔镜手术治疗结直肠癌老年患者的临床疗效分析

Analysis of Clinical Curative Effect of Endoscopic Surgery in Treatment of Senile Patients with Colorectal Cancer

目的探讨腔镜手术治疗结直肠癌老年患者的临床疗效分析。方法回顾性分析2014年12月—2016年12月在该院外科手术治疗的50例老年结直肠癌患者的临床资料,依据患者自愿原则分为两组,对照组25例采用传统开腹手术治疗,观察组25例采用腔镜手术治疗,比较两组患者的各项手术指标、手术效果、并发症发生情况。结果观察组清扫淋巴结数量(7.78±4.92)枚、切除结肠长度(21.06±7.05)cm、切除直肠长度(15.33±4.18)cm、切缘阳性为negative、肿瘤大小(4.82±2.63)cm;对照组清扫淋巴结数量(8.62±4.51)枚、切除结肠长度(19.47±7.24)cm、切除直肠长度(15.84±5.36)cm、切缘阳性为negative、肿瘤大小(4.87±2.39)cm;两组间差异无统计学意义(P>0.05);观察组手术时间(221.3±41.40)min、术中出血量(98.5±51.20)m L、切口长度(5.8±1.60)cm、术后排气时间(3.01±1.62)d、术后疼痛程度(5.26±1.07)分、下床活动时间(3.06±0.85)d、住院时间(15.9±4.20)d与对照组(174.5±52.70)min、(156.8±86.50)m L、(16.9±1.80)cm、(4.18±1.71)d、(8.75±1.43)分、(4.26±0.96)d、(21.3±8.10)d相比,差异有统计学意义(P<0.05);观察组术后肠梗阻、肠漏、肺部感染、切口感染等并发症发生率为16.0%明显低于对照组的40.0%(P<0.05),而观察组术中高碳酸血症发生率为16.0%高于对照组的4.0%,差异有统计学意义(P<0.05)。结论腔镜手术治疗结直肠癌老年患者疗效更佳,手术创伤较小,术后恢复快,并发症较少,是一种安全可行的手术方式。

Objective To study the clinical curative effect of endoscopic surgery in treatment of senile patients with colorectal cancer. Methods 50 cases of senile patients with colorectal cancer treated with operation in the department of surgery in our hospital from December 2014 to December 2016 were selected and divided into two groups according to the voluntary principle with 25 cases in each, the control group were treated with traditional open surgery, while the observation group were treated with endoscopic surgery, and the various operation indexes, operation effect and occurrence of complications were compared between the two groups. Results The differences in the lymph node dissection number, resected colon length, resected intestinum length, positive margin and tumor size between the observation group and the control group had no statistical significance [(7.78 ±4.92),(21.06 ±7.05)cm,(15.33 ±4.18)cm, negative(4.82 ±2.63)cm vs(8.62 ±4.51),(19.47±7.24)cm,(15.84±5.36)cm, negative,(4.87±2.39)cm],(P>0.05), and the differences in the operation time, intraoperative bleeding amount, cut length, postoperative exhaust time, postoperative pain degree, time to get out of bed and length of stay between the observation group and the control group had statistical significance[(221.3±41.40)min,(98.5±51.20)m L,(5.8 ±1.60)cm,(3.01 ±1.62)d,(5.26 ±1.07)marks,(3.06 ±0.85)d,(15.9 ±4.20)d vs(174.5 ±52.70)min、(156.8 ±86.50)m L、(16.9±1.80)cm、(4.18±1.71)d、(8.75±1.43)分、(4.26±0.96)d、(21.3±8.10)d],(P<0.05), and the incidence rate of complications such as postoperative intestinal obstruction, intestinal leakage, lung infection and cut infection in the observation group were obviously lower than those in the control group(16.0% vs 40.0%), and the incidence rate of intraoperative hypercarbia in the observation group was higher than that in the control group(16.0% vs 4.0%), and the difference had statistical significance,(P<0.05). Conclusion The curative effect of endoscopic surgery in treatment of senile patients with colorectal cancer is better with small operation wound and rapid postoperative rehabilitation and fewer complications, which is a safe and feasible operation method.