高龄结直肠癌患者术后并发症发生情况及危险因素分析  

Analysis of postoperative complications and risk factors in elderly patients with colorectal cancer

作　　者：安琦[1] 马福海 崔健 李子建 史金鑫 马天明 吴国举[1] 肖刚[1] An Qi;Ma Fuhai;Cui Jian;Li Zijian;Shi Jincin;Ma Tianming;Wu Guoju;Xiao Gang(Department of General Surgery,Department of Gastrointestinal Surgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,100730 Beijing,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》2023年第6期683-688,共6页Chinese Journal of Geriatrics

基　　金：中央高水平医院临床科研业务费(BJ-2022-152)。

摘　　要：目的分析高龄结直肠癌患者根治手术后并发症发生情况,明确并发症发生的危险因素。方法本研究纳入2013年1月至2020年12月在北京医院接受根治性手术的906例老年结直肠癌患者(年龄≥65岁)。根据年龄将患者分为普通老年组(年龄<80岁,695例)和高龄组(年龄≥80岁,211例)。将手术并发症分为内科并发症和外科手术相关并发症。通过对比两组患者的临床病理资料、术后恢复情况及并发症发生情况,分析高龄结直肠癌患者术后并发症发生特点。通过单因素及多因素分析明确并发症发生的危险因素。结果与普通老年组患者相比,高龄组患者体质指数偏低,具有更高的基础慢性疾病合并率和美国麻醉医师协会(ASA)分级更高;高龄组患者右半结肠癌比例、pT3-4期比例及pN+期比例较高;接受腹腔镜手术比例较普通老年组患者低;手术时间明显缩短[(191.0±70.6)min和(214.0±83.3)min,t=3.642,P<0.001];总并发症发生率较普通老年组增加(32.7%和22.6%,χ^(2)=8.839,P=0.004)。进一步分析发现仅内科并发症显著增加(20.9%和7.5%,χ^(2)=30.547,P<0.001),而外科手术相关并发症发生率差异无统计学意义(15.6%和16.4%,χ^(2)=0.069,P=0.832)。高龄组患者围术期死亡率较普通老年组显著增加(1.9%和0.3%,χ^(2)=6.316,P=0.029)。多因素分析发现高龄是影响内科并发症发生的独立危险因素(HR:2.822;95%CI:1.804~4.414;P<0.001),腹腔镜手术能显著降低外科手术相关并发症的发生(HR:0.475;95%CI:0.317~0.711;P=0.001),而手术时间大于200min能显著增加外科手术相关并发症的发生(HR:1.942;95%CI:1.278~2.888;P=0.002)。结论高龄结直肠癌患者行根治性手术术后内科并发症发生率增加,但外科手术相关并发症未增加。高龄结直肠癌患者行根治性手术是安全可行的,需要重点关注并降低围术期内科并发症的发生。Objective To examine the occurrence of complications in elderly patients who have undergone radical surgery for colorectal cancer.Additionally,this study aims to identify the various risk factors associated with these complications.Methods This study included elderly patients with colorectal cancer who underwent radical surgery at Beijing Hospital between January 2013 and December 2020.These patients were divided into two groups based on their age.In this study,we examined a total of 906 patients who underwent surgery,with 695 patients under the age of 80 and 211 patients aged 80 and above.We classified postoperative complications into two categories:medical and surgical complications.Our analysis compared comorbidities,clinicopathological factors,perioperative variables,and postoperative morbidity and mortality between the two age groups.We utilized both univariate and multivariate analyses to identify any potential risk factors for postoperative morbidity.Results When comparing patients under 80 years old to those aged 80 or older,it was found that the latter group had alowerbodymass index,worse ASA scores,and more comorbidities.Additionally,the proportion of elderly patients with right colon cancer,pT3-4,and pN+disease was higher compared to those under 80 years old.Furthermore,the elderly patients aged 80 or older had a lower rate of laparoscopic surgery compared to those under 80 years old.The study found that elderly patients aged 80 years and older had significantly shorter operation times compared to those younger than 80 years[(191.0±70.6)min vs.(214.0±83.3)min,t=3.642,P<0.001].However,the overall complication rate was higher in the elderly group(32.7%)than in the younger group(22.6%)(χ^(2)=8.839,P=0.004).Upon further analysis,it was found that medical complications increased significantly(20.9%vs.7.5%,χ^(2)=30.547,P<0.001),whereas the rate of surgical complications did not show any statistical difference(15.6%vs.16.4%,χ^(2)=0.069,P=0.832).The mortality rate during the perioperative period was found

关 键 词：直肠肿瘤 手术后并发症 危险因素 

分 类 号：R735.34[医药卫生—肿瘤]