75岁及以上高龄结直肠癌患者手术治疗安全性、远期疗效及腹腔镜手术可行性评估  

Safety and long-term outcome of surgical treatment for colorectal cancer in patients aged above 75 years and the feasibility of laparoscopic surgery

作　　者：臧怡雯[1] 周易明[1] 陈宗祜 

机构地区：[1]复旦大学附属华山医院普外科,上海200040

出　　处：《上海医学》2011年第11期831-836,共6页Shanghai Medical Journal

摘　　要：目的评估≥75岁高龄结直肠癌患者手术安全性、远期疗效及腹腔镜手术的可行性。方法回顾性分析2007年9月—2010年10月在复旦大学附属华山医院普通外科接受手术治疗的≥60岁的301例结直肠癌患者,分为高龄组(≥75岁,132例)及低龄组(≥60且<75岁,169例),评估高龄结直肠患者的手术危险因素,高龄患者接受根治手术的风险因素、安全性及远期疗效。回顾性分析2009年1月—2010年10月共27例年龄≥75岁并接受一期腹腔镜下根治性手术的结直肠癌患者(腔镜组)及同期56例年龄≥75岁并接受一期开放根治术的患者(开放组)的临床资料,比较两组近期疗效,探讨腹腔镜手术在高龄结直肠癌患者中的安全性和适用性。结果高龄组内科合并症发生率为75.8%(100/132),显著高于低龄组的50.9%(86/169,P=0.000)。高龄组术后并发症发生率为48.5%(64/132),显著高于低龄组的32.0%(54/169,P=0.004);两组手术相关死亡率分别为2.3%(3/132)、1.8%(3/169),差异无统计学意义;两组术后镇痛要求、术后排气时间、进食半流质时间、保留导尿管时间的差异均无统计学意义(P值均>0.05),高龄组术后住院时间显著长于低龄组(P<0.05)。患者随访于2011年4月30日完成,平均随访时间为(34.5±0.8)个月,其中213例健在,18例带瘤生存,59例死亡,失访11例。高龄组术后平均生存时间为(32.1±1.0)个月,术后3年总生存率为62.1%,无进展生存率为56.9%。低龄组平均生存时间为(36.6±1.2)个月,术后3年生存率为79.0%,无进展生存率为74.5%。COX多因素回归分析显示,手术根治性及肿瘤分期、分化程度是影响预后的主要因素(P值均<0.05)。结论在≥75岁高龄结直肠癌患者中,通过进行术前综合病情评估,选择合适的病例进行根治性手术治疗,加强监护,积极治疗合并症,不仅可使患者安全耐受手术,而且可获得满意的远期效果。腹腔镜手术安全可靠,近期疗效满意,应成为�Objective To evaluate surgical safety and long-term outcomes of aged colorectal patients older than 75. Methods The clinical data of 301 colorectal carcinoma patients aged above 60 years old treated by operative procedures from September 2007 to October 2010 were analyzed. They were divided into elderly group （n = 132, aged above 75 years） and the younger group （n = 169, age ranged 60--74 years）. Risk factors, safety, and long-term outcomes of radical operation were compared between the two groups. Between January 2009 and October 2010, 27 Patients （≥75 years） with colorectal cancer underwent laparoscopic-assisted onestage radical operation （LAP group） in our hospital, and 56 patients （≥75 years） underwent open radical operation in the same period （OPEN group）. Short-term outcomes were compared to investigate the safety and possibility of laparoscopic procedures in elderly patients with colorectal carcinoma. SPSS 17.0 software was used for statistic analysis. Results Compared with the patients in younger group （60--74 years）, co-morbidity rate was higher in the elderly group （≥75 years）. However, there was no significant difference in complication rate or 30-day mortality between the two groups. Bowel functional recovery was similar as well. We also found laparoscopic operation need a longer surgical time, but had much smaller incision and faster bowel functional recovery, compared with OPEN group. There was no statistical difference in the incidence of postoperative complications. Until April 30th, 2011, 213 patients were alive without progression, 18 lived with tumor, 59 were dead, and the other 11 patients were withdrawn. The average follow-up was （34.5±0.8） months. In elderly group, 3-year survival rate and disease-free survival rate were 62.1% and 56.9%, with an average follow-up of （32.1± 1.0） months. Meanwhile the average follow-up of younger group was （36.6±1.2） months. 3-year survival rate and disease-free survival rate were 79.0% and 74.5%. In multiva

关 键 词：高龄 结直肠癌 手术安全性 生存分析 腹腔镜手术 

分 类 号：R735.3[医药卫生—肿瘤]