老年晚期结肠癌患者行姑息切除术与造瘘术的疗效观察

Efficacy of palliative resection and ostomy in elderly patients with advanced colon cancer

目的探讨晚期结肠癌老年患者行姑息切除术与造瘘术的疗效。方法选取2017年10月至2020年3月间西安市中心医院诊治的152例晚期老年结肠癌患者作为研究对象,根据采用的治疗方法不同进行分组,采用器械造瘘手术治疗的76例患者纳入造瘘组,采用姑息切除手术治疗的76例患者纳入姑息组。记录与随访两组患者的预后情况。结果两组患者的手术时间、术中出血量、术后引流管拔除时间比较,差异无统计学意义(P>0.05)。姑息组的术后首次排气时间、术后首次进食时间和术后住院时间均少于对照组,差异均有统计学意义(均P<0.05)。姑息组术后1d、3d与7d的疼痛视觉模拟评分(VAS)均低于造瘘组,差异均有统计学意义(均P<0.05)。姑息组术后1个月的切口感染、腹腔感染、肺部感染、吻合口出血和泌尿道感染等并发症发生率为3.9%,低于对照组的18.4%,差异有统计学意义(P<0.05)。姑息组随访半年与1年的生存率分别为88.2%和73.7%,高于造瘘组的71.0%和59.2%,差异均有统计学意义(均P<0.05)。结论相对于造瘘术,姑息切除术在晚期结肠癌老年患者的应用,能促进患者短期康复,缓解疼痛状况,减少并发症的发生,提高随访生存率。

Objective To compare and observe the treatment effect of palliative resection and ostomy in elderly patients with advanced colon cancer.Methods From October 2017 to March 2020,152 elderly patients with advanced colon cancer who were diagnosed and treated at Xi’an Central Hospital were selected.They were divided into groups based on the therapies they received.Seventy-six patients undergoing colostomy surgery were enrolled in an ostomy group and 76 patients undergoing alliative resection were enrolled in a palliative treatment group.The prognosis were recorded and followed up in the two groups.Results There were no statistically significant difference in the duration of operation,intraoperative blood loss,time to postoperative drainage tube removal compared between the two groups(P>0.05).Time to postoperative passing gas,time to postoperative eating,and length of postoperative hospital stay were less in the palliative treatment group than in the ostomy group(all P<0.05).The visual analogue scale(VAS)at1,3 and 7 d after operation were lower in the palliative treatment group than in the ostomy group(all P<0.05).The incidence of complications such as incision infection,abdominal cavity infection,lung infection,anastomotic bleeding,and urinary tract infection in the palliative treatment group at 1 month after operation were 3.9%,which were lower than 18.4%of the ostomy group(all P<0.05).The half-year and1-year survival rate was 88.2%and 73.7%,respectively in the palliative group,which was higher than the71.0%and 59.2%,respectively of the ostomy group(all P<0.05).Conclusion Compared with ostomy,palliative resection can promote short-term recovery,relieve pain,reduce the incidence of complications,and improve the survival rate in elderly patients with advanced colon cancer.