高龄患者腹腔镜辅助结直肠癌切除术的临床疗效  

Clinical efficacy of laparoscopic-assisted resection of colorectal cancer in elderly patients

作　　者：韩越俊[1] 王建平[1] 王庆华[1] 杜金林[1] 

机构地区：[1]浙江省金华市中心医院结直肠肛门外科,浙江金华321000

出　　处：《中国普通外科杂志》2017年第4期463-467,共5页China Journal of General Surgery

基　　金：浙江省金华市科学技术局社会发展类重点基金资助项目(2016-3-006)

摘　　要：目的:探讨高龄患者(≥70岁)行腹腔镜辅助结直肠癌切除术的安全性和有效性。方法:根据纳入与排除标准,前瞻性纳入2012年1月―2015年1月收治的高龄结直肠癌患者120例,将患者随机分为腹腔镜组和开腹手术组,每组60例,分别行腹腔镜辅助结直肠癌切除术和开腹结直肠癌切除术。比较两组患者的相关临床指标。结果:与开腹组比较,腹腔镜组手术时间(118.23min vs.120.85min,P=0.458)与淋巴结清扫数目(18.12枚vs.17.37枚,P=0.218)无统计学差异,但术中出血量明显减少(307.28mL vs.354.80mL,P=0.000)、术后排气时间明显缩短(38.27h vs.47.02h,P=0.000)、住院时间明显缩短(16.58d vs.20.07d,P=0.000)。两组患者肠瘘、皮下感染、吻合口瘘、肠梗阻、尿路感染和肺部感染发生率差异均无统计学意义(均P>0.05)。两组患者术后24个月时复发率(35.0%vs.41.7%,P=0.453)与病死率(13.3%vs.18.3%,P=0.453)差异均无统计学意义。结论:高龄患者行腹腔镜辅助结直肠癌切除术安全有效,值得进一步推广。Objective： To investigate the safety and effectiveness of laparoscopic-assisted resection of colorectal cancer in elderly patients （≥70 years of age）.Methods： According to the inclusion and exclusion criteria, 120 elderly patients with colorectal cancer admitted between January 2012 and January 2015 were prospectively enrolled, and randomly designated to laparoscopic group and laparotomy group with 60 cases in each group, undergoing laparoscopic-assisted or open resection of colorectal cancer, respectively. The main clinical variables between the two groups of patients were compared.Results： In laparoscopic group compared with laparotomy group, the operative time （118.23 min vs.120.85 min, P=0.458） and number of resected lymph nodes （18.12 vs.17.37,P=0.218） showed no significant difference,but the intraoperative blood loss （307.28 mL vs.354.80 mL,P=0.000）, time to first postoperative flatus （38.27 h vs.47.02 h,P=0.000） and length of hospital stay （16.58 d vs.20.07 d,P=0.000） were all significantly reduced. No statistical difference was noted in incidence of postoperative complications that included intestinal fistula, subcutaneous infection, anastomotic fistula, intestinal obstruction, urinary tract infection and lung infection （allP〉0.05）. The recurrence rate （35.0% vs.41.7%,P=0.453） and mortality rate （13.3% vs.18.3%, P=0.453） at postoperative 24 months had no statistical difference between the two groups.Conclusion： Performance of laparoscopic-assisted resection of colorectal cancer in elderly patients is safe and effective, and it is recommended to be used.

关 键 词：结直肠肿瘤 腹腔镜 老年人 

分 类 号：R735.3[医药卫生—肿瘤]