基于倾向得分匹配法的高龄患者腹腔镜辅助直肠癌根治术疗效分析

Efficacy analysis of laparoscopic-assisted radical resection in elderly rectal cancer patients based on propensity score matching

目的:评估腹腔镜辅助直肠癌根治术在高龄直肠癌患者(≥70岁)中运用的可行性和安全性。方法:回顾性分析2014年1月—2016年1月在安徽省立医院普外科胃肠外科专业行腹腔镜辅助直肠癌根治术的226例直肠癌患者,依据年龄分为高龄组(≥70岁)和非高龄组(<70岁),采用倾向得分匹配法从高龄组和非高龄组患者中分别抽取46例患者,对两组的临床指标进行统计学分析。结果:高龄组和非高龄组患者的平均年龄分别为76.3与59.1岁;两组患者的性别比例、术前合并症、ASA分级等基线指标差异无统计学意义(均P>0.05)。两组患者在手术时间、术中出血、手术方式的选择、肿瘤大小、淋巴结切除数目、术后病理分期、术后进食流质时间、术后住院时间差异均无统计学意义(均P>0.05)。两组患者术后均无死亡病例;高龄组和非高龄组患者术后并发症发生率(22%vs.15%)、术后感染相关并发症发生率(15%vs.7%)差异均无统计学意义(均P>0.05)。结论:高龄患者行腹腔镜辅助直肠癌根治术安全、可行,且与非高龄患者相比,并不增加术后并发症发生率。

Objective： To assess feasibility and safety of performing laparoscopic-assisted radical resection（LARR） for rectal cancer in elderly patients. Methods： The clinical data of 226 rectal cancer patients undergoing LARR in the Department of General Surgery of Anhui Provincial Hospital from January 2014 to January 2016 were retrospectively analyzed. Patients weredivided according to age, into elderly group（≥70 years of age） and non-elderly group（70 years of age）. Forty-six patients in each group were selected using propensity score matching, and then, the clinical variables between the two groups were statistically analyzed.Results： The mean age was 76.3 and 59.1 years in elderly group and non-elderly group, respectively. The baseline data that included gender, preoperative concomitant disease and ASA grade showed no significant difference between the two groups（all P〉0.05）. The operative time, intraoperative blood loss, surgical procedures, tumor size, number of harvested lymph nodes, TNM stage, time to liquid diet and length of postoperative hospital stay, all showed no significant difference between the two groups（all P〉0.05）. No death occurred in either of the groups. In elderly group and non-elderly group, the differences concerning the incidence of postoperative complications（22% vs. 15%） and incidence of infection-related complications（15% vs. 7%） also showed no significant difference（both P〉0.05）.Conclusion： LARR for rectal cancer is safe and feasible in elderly patients and, compared with non-elderly patients, does not increase the incidence of postoperative complications.