80岁及以上结直肠癌患者腹腔镜手术的短期和长期疗效观察  

Short-term and long-term outcomes of laparoscopic surgery for colorectal cancer patients aged 80 years and over

作　　者：安琦[1] 马福海 崔健 李子建 史金鑫 吴国举[1] An Qi;Ma Fuhai;Cui Jian;Li Zijian;Shi Jinxin;Wu Guoju(Department of General Surgery,Department of Gastrointestinal Surgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院普通外科胃肠外科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730

出　　处：《中华老年医学杂志》2022年第8期970-974,共5页Chinese Journal of Geriatrics

摘　　要：目的评价腹腔镜手术应用于高龄(80岁及以上)结直肠癌患者的短期和长期疗效。方法本研究纳入北京医院2013年1月至2020年12月行手术治疗的高龄乙状结肠及直肠癌的患者, 其中腹腔镜手术47例, 开腹手术44例。倾向性评分匹配(PSM)进行1∶1匹配后, 腹腔镜手术和开腹手术组各32例, 比较分析了两组患者的临床病理资料、手术资料、术后疗效和长期生存情况。结果 PSM匹配前, 开腹手术组和腹腔镜手术组性别及肿瘤位置具有统计学差异。经PSM匹配后两组基本临床资料及病理特征相比差异无统计学意义。在PSM匹配前后, 腹腔镜手术时间均较开腹手术时间延长。术中出血量、术后并发症发生率以及手术清扫淋巴结个数在PSM匹配前后均两组相比差异均无统计学意义。PSM匹配前后, 腹腔镜手术组术后住院天数均较开腹手术组缩短, 但差异无统计学差异。PSM匹配前, 开腹手术组的1年、3年和5年生存率分别为92.4%、69.5%和58.1%, 腹腔镜手术组的1年、3年和5年生存率分别为91.3%、79.8%和69.5%, 两组总生存相比差异无统计学意义(χ^(2)=0.591, P=0.422)。PSM匹配后, 开腹手术组的1年、3年和5年生存率分别为89.3%、67.1%和52.2%, 腹腔镜手术组的1年、3年和5年生存率分别为90.6%、74.3%和65.0%, 两组总生存无统计学差异(χ^(2)=1.316, P=0.251)。结论高龄乙状结肠癌和直肠癌患者, 腹腔镜手术和开腹手术术后并发症发生率相似, 术后长期生存无差异。本研究为腹腔镜手术应用高龄患者结直肠癌患者的安全性提供一定的证据, 尚需要前瞻性的随机对照研究进一步证实。Objective To investigate the short-term and long-term efficacy of laparoscopic surgery for colorectal cancer in elderly patients aged 80 and over.Methods This study included patients aged 80 and over with sigmoid or rectal cancer who had undergone radical surgery in Beijing Hospital between January 2013 and December 2020.Of the enrolled patients,47 underwent laparoscopic surgery,and 44 received open surgery.After 1∶1 propensity score matching(PSM),there were 32 cases in each group.Patient clinicopathological characteristics,surgery data,post-operative outcomes and long-term survival were compared.Results Before PSM,there were significant differences in sex composition and tumor locations between the open surgery and laparoscopic surgery groups.After PSM,there was no significant difference in clinicopathological characteristics between the two groups.Before and after PSM,the operative time for laparoscopic surgery was statistically longer than that for open surgery.The intraoperative blood loss,the postoperative complication rate and the number of harvested lymph nodes were not significantly different between the two groups before and after PSM.Before and after PSM,the postoperative hospital stay in the laparoscopic operation group was shorter than that in the open surgery group,but the difference was not statistically significant.Before PSM,the 1-year,3-year and 5-year survival rates of the open surgery group were 92.4%,69.5%and 58.1%,respectively,and the 1-year,3-year and 5-year survival rates of laparoscopic group were 91.3%,79.8%and 69.5%,respectively.There was no significant difference in overall survival between the two groups before PSM(χ2=0.591,P=0.422).After PSM,the 1-year,3-year and 5-year survival rates in the open surgery group were 89.3%,67.1%and 52.2%,respectively,and the 1-year,3-year and 5-year survival rates in the laparoscopic surgery group were 90.6%,74.3%and 65.0%,respectively.There was no significant difference in the overall survival between the two groups after PSM(χ2=1.316,P=0.251).Conc

关 键 词：高龄患者 结直肠癌 腹腔镜手术 并发症 长期生存 

分 类 号：R735.34[医药卫生—肿瘤]