腹腔镜与开腹手术治疗老年结肠癌的临床疗效对比分析

Comparison of clinical efficacy of laparoscopic and open surgery for elderly colon cancer patients

目的探讨腹腔镜手术在老年结肠癌治疗中的临床应用,比较其与传统开腹手术的安全性和疗效。方法老年结肠癌病人(年龄>70岁)139例,其中腹腔镜组76例,行腹腔镜辅助结肠癌根治术;开腹组63例,行开腹结肠癌根治术。比较两组围手术期指标及临床疗效。结果腹腔镜组、开腹组平均手术时间分别为150.0 min和132.5 min,术中平均失血量分别为80 ml和120 ml,两组比较差异有统计学意义(P<0.05);腹腔镜组进流食时间、术后肠道功能恢复时间、住院时间均短于开腹组,腹腔镜组术后并发症率明显低于开腹手术组,两组比较差异有统计学意义(P<0.05),两组清扫淋巴结个数、3年总生存率和无病生存率比较差异无统计学意义(P>0.05)。结论经充分准备、严格掌握适应证的情况下,腹腔镜手术在老年结肠癌治疗中与开腹手术比较,具有术中出血少、术后恢复快等优势,远期生存率与开腹手术相当。

Objective To investigate the clinical efficacy of laparoscopic surgery for elderly colon cancer patients and evaluate its safety and feasible. Methods 139 elderly patients undergone laparoscopic or open surgery for colon cancer. 76 patients of them underwent laparoscopic surgery and 63 patients underwent open surgery. Perioperative indicators and clinical efficacy were compared between two groups. Results The operating time was significantly longer in the laparoscopic group compared with open group（ 150. 0 min vs 132. 5 min,P〈0. 05）,but the blood loss during the operation was lower in the laparoscopic group（ 80 ml vs 120 ml,P〈0. 05）. Regarding perioperative outcomes,the time of first oral intake,the time of bowel function recovery,and the postoperative hospital stay were shorter in the laparoscopic group（ P〈0. 05）. With regard to complication rate,wound complication occurred significantly less frequently in the laparoscopic group（ P〈0. 05）. There were no significantly difference in the number of harvested lymph nodes,3-year disease-free and overall survival outcomes between two groups（ P〉0. 05）.Conclusion Compared to open surgery,laparoscopic surgery for elderly colon cancer patients is associated with equivalent survival outcomes and better short-term outcomes including less blood loss and faster bowel recovery. Therefore,laparoscopic surgery is able to be a safety and feasible approach for elderly colon cancer patients after complete evaluation.