80岁以上合并肠梗阻的结直肠癌患者的外科治疗

Surgical Treatment of Colorectal Cancer Patients with Ileus Aged Over 80 Years

目的探讨80岁以上合并肠梗阻的结直肠癌患者的外科治疗策略。方法回顾性分析中国医学科学院结直肠外科2007年1月—2018年12月行结直肠癌手术且术前合并肠梗阻的77例80岁以上患者的临床病理资料,按照手术方式分为根治组(n=58)与非根治组(n=19),比较两组患者临床病理特征、围手术期相关指标和预后。采用Kaplan-Meier法进行生存分析,Log rank检验进行生存时间比较;应用Cox比例风险模型进行多因素分析,对影响预后的因素进行分析。结果根治组TNM分期为Ⅳ期患者的比例明显低于非根治组(8.6%vs.57.9%,P<0.001)。根治组患者的5年生存率明显高于非根治组(65.5%vs.26.3%,P<0.001)。单因素分析显示TNM分期和是否行根治性手术与合并肠梗阻的老年结直肠癌患者预后相关。多因素分析表明是否行根治性手术是影响80岁以上合并肠梗阻的结直肠癌患者预后的独立因素。结论是否行根治性手术是影响80岁以上合并肠梗阻的结直肠癌患者预后的独立因素。

Objective To investigate the surgical treatment strategy for colorectal cancer patients with ileus aged over 80 years old.Methods We retrospectively collected and analyzed the clinicopathological data of patients with preoperative ileus aged over 80 years old who underwent colorectal cancer surgery from January 2007 to December 2018.According to the surgical method,the patients were divided into the radical surgery group(n=58)and the non-radical surgery group(n=19).The clinicopathological characteristics,perioperative indicators and prognosis of the two groups were compared.Kaplan-Meier method was used for survival analysis and Cox regression analysis was conducted to analyze prognostic factors.Results A total of 77 patients were included.The proportion of patients with stageⅣin the radical treatment group was significantly lower than that in the non-radical treatment group(P<0.001).The 5-year survival rate of the radical surgery group was significantly higher than that of the non-radical surgery group(P<0.001).Univariate analysis showed that the predictors for survival were TNM stage and radical surgery.Multivariate analysis showed that radical surgery was an independent factor affecting the prognosis of colorectal cancer patients with ileus aged over 80 years old.Conclusion Radical surgery is an independent factor affecting the prognosis of colorectal cancer patients with ileus aged over 80 years old.