快速康复外科腹腔镜直肠癌根治术在老年患者中的临床应用

Clinical application of fast track surgery, laparoscopic radical resection of rectal cancer in elderly patients

目的对比70岁以上老年直肠癌患者应用快速康复理念腹腔镜手术治疗和传统开腹手术治疗两组患者疗效的区别，证明快速康复理念腹腔镜手术治疗70岁以上老年直肠癌患者的优势和实用价值。方法回顾性分析2010年4月至2016年11月湖南省第二人民医院收治的100例70岁以上高龄直肠癌患者的临床资料，按照腹腔镜组和开腹组的入组要求，50例患者接受快速康复理念腹腔镜辅助直肠癌根治术（观察组）；另50例患者接受常规开腹手术（对照组）。分别比较两组患者的术前临床资料，术中术后相关指标情况。结果两组患者在手术方式方面差异无统计学意义（P〉0．05），观察组手术时间长于对照组[（190±35．2）minvs（160．5±29．3）min，P〈0．05]，观察组高碳酸血症发生率高于对照组（P〈0．05），观察组术中出血量明显少于对照组[（90±40）ml vs（130±60）ml，P〈0．05]，观察组术后排气时间短于对照组[（3．01±0．98）dVS（3．98±1．38）d，P〈0．05]，观察组清扫淋巴结枚数与对照组比较差异无统计学意义（12．86±4．87VS13．12±4．69，P〉0．05），观察组住院时间明显短于对照组[（15．68±5．10）d vs（20．31±6．78）d，P〈0．05]，观察组伤口感染率明显低于对照组（P〈0．05），观察组吻合口漏、吻合口狭窄发生率与对照组比较差异无统计学意义（P〉0．05）。结论快速康复理念腹腔镜直肠癌根治术在保证了根治效果的同时，还具有出血少，恢复快，并发症少等优点，安全可行，值得临床推广应用。

Objective To investigate the curative effect of fast track surgery laparoscopic surgery and traditional laparotomy in elderly patients over 70 years old with rectal cancer and the difference between the two groups was analyzed, and explore the practical value and the advantages in fast track surgery （FTS） laparoscopic surgery in the patients older than 70 years with colorectal cancer. Methods This study was a retrospective analysis, in accordance with the requirements of the laparoscopic group and the laparotomy group, the clinical data of 100 patients over 70 years old with rectal cancer were randomly sampled who were admitted to the second peopleg Hospital of Hunan province in April 2010 - 2016 November. Fifty patients underwent FTS laparoscopic assisted rectal cancer, which was set as the experimental group; the other 50 patients underwent conventional open surgery were set as the control group. The clinical data of two groups were compared with preoperative, intraoperative and postoperative related indicators. Results No signifi- cant difference was found in the two groups of patients in sm＇gery （ P 〉 0. 05 ）. The operative time of experimental group was [ （ 190± 35.2 ） rain ] longer than the control group [ （ 160. 5±29.3 ） min] （ P 〈 0.05 ）. The incidence of hypercapnia in the experimental group was higher than the control group （P 〈 0. 05 ）. The intraoperative bleeding of the experimental group [ （90± 40） ml] was significantly less than the control group [ （130±60）ml, P 〈0. 05 ]. The postoperative exhaust time of the experimental group [ （3.01±0. 98）d] was shorter than the control group [ （3.98±1.38）d, P 〈0. 05]. The lymph node number of the experimental group （ 12. 86 ＋4. 87） was not significantly different from control group （ 13.12±4. 69, P 〉 0. 05）. The hospitalization time of the experimental group [ （15.68±5. 10） d] was significantly shorter than the control group [ （20. 31±6. 78）d, P 〈0. 05]. The wound infection rate of experimental group was significantly lower than the control group （ P 〈 0. 05 ）. The anastomotic leakage in experimental group was not significantly different from control group （ P 〉 0. 05）. No significant difference in anastomotic stenosis was found between the experimental group and the control group （ P 〉 0. 05 ）. Conclusions The concept of FTS laparoscopic radical resection of rectal cancer has the advantages including less bleeding, quicker re- covery, and less complications. It is safe and feasible and worthy of clinical application.