不同年龄段老年结直肠癌患者术后临床特征分析

Contrastive analysis about the postoperative clinical characteristics of elderly patients with colorectal cancer in different age groups

目的:了解不同年龄段老年结直肠癌发病特点,探究不同年龄段老年结直肠癌患者术后临床特征。方法:回顾性分析了2012年1月至2019年12月就诊于北京医院胃肠外科的720例老年结直肠癌患者的临床病历资料,其中男411例,女309例,中位年龄为74岁。通过年龄将患者分为年轻老年人(65~74岁,359例)组、中年老年人(75~84岁,323例)以及高龄老年人(≥85岁,37例)3组,利用χ2检验比较分析不同组患者的临床及病理特征差异。结果:高龄老年人结直肠癌发病部位随着年龄的增长右移(35.0%、41.7%、48.6%),高龄老人组发病部位主要集中于右半结肠达48.6%。随着年龄增长,心脏疾病及高血压等伴随疾病发病率逐步升高,中年老年结直肠癌患者中冠心病比例最高(27.8%、37.2%、32.4%, P=0.033),而糖尿病发病率在中年老年结直肠癌患者组达到最高30.7%(99/186)。此外,高龄老年人开腹手术比例高达75.7%(28/37),手术时间反而短于其余两组。老年结直肠癌患者术后并发症的发病率随着年龄增长逐步升高,尤其是心脏并发症及肺炎、下肢深静脉血栓、尿潴留、泌尿系感染、肾衰、脑出血、脑梗死等其他并发症。 结论:高龄老年人结直肠癌发病部位右移。老年结直肠癌患者随着年龄增长,心脏疾病及高血压等伴随疾病发病率及术后并发症的发生率逐步升高。针对不同年龄段的老年结直肠癌患者治疗方案的选择应该注重个体化,注重围手术期相关伴随疾病的管理。

Objective To explore the postoperative clinical characteristics of elderly patients with colorectal cancer at different ages.Methods Retrospective analysis was performed on the clinical data of 720 elderly patients with Colorectal Cancer in Beijing Hospitals from January 2012 to December 2019.There were 411 males and 309 females with a median age of 74 years.We divided the patients into young-old,old-old,oldest-old colorectal cancer patient groups and used chi-square comparative analysis of different groups of patients with clinical disease characteristics.Results The oldest-old colorectal cancer patients tended to have normal body mass index(BMI),and the site of the disease shifted to the right.The incidence of concomitant diseases such as heart disease and hypertension increases gradually with age,and the incidence of diabetes is highest in old-old colorectal cancer patients.The proportion of open surgery was higher in the oldest-old group,but the operation time was shorter than the other two groups.In addition,the incidence of postoperative complications in elderly patients with colorectal cancer gradually increases with age,especially cardiac complications and other complications such as pneumonia,deep venous thrombosis of lower limbs,urinary retention,urinary tract infection,renal failure,cerebral hemorrhage,cerebral infarction,and so on.Conclusions The BMI of the oldest-old patients tended to be normal,and the site of the disease shifted to the right.The incidence of heart disease,hypertension,and other concomitant diseases and postoperative complications in elderly patients with colorectal cancer gradually increase with age.Thus,the choice of treatment should be more individualized for elderly patients with colorectal cancer,and more attention should be paid to perioperative management.