腹腔镜根治术与开腹根治术治疗老年大肠癌患者的临床对比研究

A comparative study of laparoscopic radical colectomy and open radical colorectal resection for senile patients with colorectal cancer

目的对比分析腹腔镜根治术和开腹根治术治疗老年大肠癌患者的临床效果。方法选取2010年6月~2013年6月广东药科大学附属第一医院普外科收治的112例大肠癌患者作为研究对象,根据手术方法不同分为腹腔镜组(57例)和开腹组(55例)。比较两组患者的手术时间、清扫淋巴结数、术中出血量、术后首次下床活动时间及胃肠道功能恢复时间、并发症(切口脂肪液化或感染、吻合口出血、吻合口瘘、粘连性肠梗阻、深静脉血栓、脑梗死及肺部感染)发生率和住院总时间;比较两组患者术后1、2和3年的生存率及复发率。结果两组患者手术时间、清扫淋巴结数比较,差异无统计学意义(P>0.05);腹腔镜组术中出血量明显减少(P<0.05),术后首次下床活动时间、胃肠道功能恢复时间和总住院时间均明显缩短(P<0.05);腹腔镜组术后切口脂肪液化或感染、吻合口出血、吻合口瘘、粘连性肠梗阻、深静脉血栓、脑梗死及肺部感染等并发症发生率明显降低,差异均有统计学意义(P<0.05)。腹腔镜组术后1、2和3年生存率分别为100.00%、92.89%和91.22%,复发率分别为3.50%、5.26%和8.77%;开腹组术后1、2和3年的生存率分别为98.18%、92.72%和90.90%,复发率分别为3.63%、5.45%和10.90%;两组患者的生存率和复发率比较,差异均无统计学意义(P>0.05)。结论腹腔镜根治术治疗老年大肠癌患者是安全可行的,其临床效果优于传统开腹根治手术,具有良好应用前景。

Objective To investigate the clinical efficacy of laparoscopic radical colectomy and open radical colorectal resection for senile patients with colorectal cancer.Methods A total of 112 senile patients with colorectal cancer enrolled in the First Affiliated Hospital of Guangdong Pharmaceutical University from June 2010 to June 2013 were selected as research objects.The patients were divided into laparoscopic group（n=57） and laparotomy group（n=55）,according to different operation methods.The following indexes of the two groups were compared ：operation time,number of resected lymph nodes,intraoperative bleeding loss,postoperative ambulation time,gastrointestinal function recovery time,complications（incision fat liquefaction and infection,anastomotic bleeding,anastomotic fistula,ileus,deep vein thrombosis,cerebral infarction and pulmonary infection incidence rate and total hospitalization time.The survival rate and recurrence rate of the two groups were compared at 1,2 and 3 years after operations.Results There was no significant difference in the operation time and the number of resected lymph nodes in the two groups（P〉0.05）.The amount of bleeding in the laparoscopic group was significantly reduced（P〈0.05）.The postoperative ambulation time,gastrointestinal function recovery time and total hospitalization time in the laparoscopic group was significantly shortened（P〈0.05）.Postoperative complications such as incision fat liquefaction and infection,anastomotic bleeding,anastomotic fistula,adhesive ileus,deep vein thrombosis,cerebral infarction and pulmonary infection rate of the laparoscopic group were lower than those in the laparotomy group,and the differences were statistically significant（P〈0.05）.The survival rates at 1,2,and 3 years after the operation were 100.00%,92.89% and 91.22% in the laparoscopic group and 98.18%,92.72% and 90.90% in the laparotomy group.The recurrence rates at 1,2,and 3 years after the operation were 3.50%,5.26% and 8.77% in the laparoscopic group,and 3.63%,5.45% and 10.90% in the laparotomy group.There was no significant difference in the survival rate and recurrence rate between the two groups（P〉0.05）.Conclusion Laparoscopic radical surgery for elderly patients with colorectal cancer is safe and feasible,and its clinical effect is superior to traditional open radical surgery,and has a good application prospect.