75岁龄及以上T4b直肠癌患者手术方式选择研究

Study on surgical methods of T4b rectal cancer in patients over 75 years of age

目的通过比较75岁以上术前评估直肠癌侵犯周围脏器(T4b)的直肠癌患者的手术方法,探索适用于此类患者的最佳术式。方法对遵义医科大学附属贵航300医院普外科2015年5月至2017年5月收治的86例术前评估直肠癌侵犯周围脏器(T4b)的75岁及以上患者围手术期资料进行统计分析,比较三种不同术式(姑息性肿瘤切除+结肠造瘘;单纯结肠造瘘术;直肠癌根治术联合周围脏器切除)的术后并发症、术后生活质量及术后3年生存率。结果三种术式中1年、3年生存率比较:姑息性肿瘤切除组与根治手术组差异无统计学意义(P>0.05),单纯结肠造瘘组生存率较低,差异有统计学意义(P<0.05)。术后并发症发生率比较:单纯结肠造瘘组较低,差异有统计学意义(P<0.05)。根治手术组较高,差异有统计学意义(P<0.05)。术后6个月生活质量影响评分:根治手术组影响较大,姑息手术组与单纯结肠造瘘组影响较小,差异有统计学意义(P<0.05)。结论对于超过75岁的高龄直肠癌患者若术前评估存在脏器侵犯,姑息性肿瘤切除+结肠造瘘的手术方式患者综合受益较高,值得临床应用。

Objective By comparing the surgical methods of rectal cancer patients over 75 years old who were evaluated preoperatively for rectal cancer invading the surrounding organs(T4b),to explore the best surgical method for such patients.Methods The perioperative data of 86 patients aged 75 and over who were admitted to the Department of General Surgery of Guihang 300 Hospital affiliated to Zunyi Medical University from May 2015 to May 2017 were analyzed statistically.Three different surgical procedures(palliative tumor resection+colostomy;2.Radical resection of rectal cancer combined with resection of surrounding organs;3,simple colostomy)postoperative complications,postoperative quality of life and postoperative 3-year survival rate were compared.Results Comparison of 1-year and 3-year survival rates of the three surgical methods:there was no significant difference between the palliative tumor resection group and the radical surgery group(P>0.05),and the survival rate of the simple colostomy group was lower,the difference was statistically significant(P<0.05).The incidence of postoperative complications was lower in the simple colostomy group,and the difference was statistically significant(P<0.05).Radical surgery group was higher,and the difference was statistically significant(P<0.05).Impact score of life quality 6 months after operation:radical surgery group had greater impact,palliative surgery group and simple fistula group had less impact,the difference was statistically significant(P<0.05).Conclusion For elderly patients with rectal cancer over 75 years old,if the preoperative evaluation of the presence of organ invasion,palliative tumor resection+colostomy surgery is highly beneficial and worthy of clinical application.