加速康复外科在老年结直肠癌患者中的应用

Application of enhanced recovery after surgery in aged patients undergoing radical colorectal surgery

目的探讨围手术期中将加速康复外科(ERAS)理念应用于老年结直肠癌患者的安全性和有效性。方法收集2015年2月至2017年1月烟台毓璜顶医院应用ERAS理念的结直肠癌手术患者的临床资料,共纳入160例患者,根据年龄分为青年组(<65岁,97例)和老年组(≥65岁,63例),对比研究两组患者的胃肠功能恢复情况、术后并发症、术后住院时间。结果相对于青年组,老年组患者ASA评分更高(χ2=10.960,P=0.001),并且明显合并更多的基础病(P<0.05)。两组患者手术类型、手术方式以及术后并发症总发生率、严重并发症发生率差异无统计学意义(χ2=0.171、1.039、0.296、0.001,P=0.680、0.595、0.586、0.979)。老年组患者非手术并发症尤其是心血管并发症更常见。青年组患者二次手术率为6.2%,再入院率为5.2%;老年组分别为9.5%、3.2%,两组差异无统计学意义(χ2=0.641、0.041,P=0.433、0.839)。老年组患者肠功能恢复较慢,术后首次肛门排气、术后首次肛门排便、住院时间较青年组患者明显延长(Z=1.89、2.37、3.11,P=0.034、0.013、0.001)。结论加速康复外科在老年患者结直肠癌手术中的应用是安全有效的。

Objective To evaluate the safety and efficacy of enhanced recovery after surgery（ERAS） combined with radical colorectal surgery for aged patients with colon cancer or rectal cancer. Methods From February 2015 to January 2017, the clinical data of one hundred and sixty patients undergoing radical colorectal cancer surgery combined with ERAS in Yantai Yuhuangding Hospital were collected. They were divided into two groups： the young group（〈 65 years old, 97 cases） and the elderly group（ ≥ 65 years old, 63 cases）. The recovery of gastrointestinal function, postoperative complications and the length of hospital stay between the two groups were compared. Results Compared with the young group, ASA score and the ratio of basic diseases of the elderly patients were higher（χ2=10.960, P=0.001）. There was no significant difference in the type of operation, the mode of operation, the rate of postoperative complications and the incidence of serious complications between the two groups（χ2=0.171, 1.039, 0.296, 0.001, P=0.680, 0.595, 0.586, 0.979）. Non-operative complications, especially cardiovascular complications, were more common in the elderly patients. The incidence of reoperation and readmission were 6.2%, 5.2% in the young group, and 9.5%, 3.2% in the elderly group respectively, with no statistical differences（χ2=0.641, 0.041, P=0.433, 0.839）. In the elderly group, intestinal function recovery was slower, postoperative anal exhaust, postoperative anal defecation and hospitalization time were significantly longer than those in the young group（Z=1.89, 2.37, 3.11, P=0.034, 0.013, 0.001）. Conclusion The combination of ERAS and radical colorectal surgery is safe and effective in aged patients with colon cancer or rectal cancer.