80岁以上合并2型糖尿病的结直肠癌患者腹腔镜根治术后疗效的倾向性匹配研究  

Propensity score matching study of outcomes of elderly patients over 80 years of age with preoperative combined type 2 diabetes mellitus following laparoscopic colorectal cancer resection

作　　者：张珍瑜 郭智 刘洋[1] 齐恒铎 张伟[1] 蔺光帅 李小军[1] Zhang Zhenyu;Guo Zhi;Liu Yang;Qi Hengduo;Zhang Wei;Lin Guangshuai;Li Xiaojun(Department of General Surgery,Shaanxi Provincial People′s Hospital,Xi′an 710068,China;Xi′an Medical College Graduate School,Xi′an 710021,China)

机构地区：[1]陕西省人民医院普外科,西安710068 [2]西安医学院研究生院,西安710021

出　　处：《国际外科学杂志》2023年第5期299-306,I0004,共9页International Journal of Surgery

摘　　要：目的探讨80岁以上且术前合并2型糖尿病(T2DM)的结直肠癌患者腹腔镜根治术后疗效。方法回顾性分析2015年1月—2019年1月在陕西省人民医院行结直肠癌腹腔镜根治手术的919例患者的临床病理资料,其中男性496例,女性423例,年龄19~92岁,中位年龄64岁。采用倾向性评分匹配(PSM)对年龄≥80岁且合并T2DM与年龄<80岁未合并糖尿病患者性别、美国麻醉医师(ASA)评分、术前血清白蛋白水平、体重指数、术前血红蛋白含量、临床肿瘤病理TNM分期、肿瘤手术位置、其他疾病合并症和腹部外科手术史行1∶1匹配,最终104例年龄≥80岁且合并T2DM患者(高龄糖尿病组)与另外104例年龄<80岁未合并糖尿病的患者(非高龄非糖尿病组)成功匹配。观察指标:(1)比较匹配后两组患者手术时间、术中出血量、术中输血人数、淋巴结清扫数量、ICU治疗人数、术后排气时间及术后住院时间、术后辅助化疗的差异;(2)观察两组患者术后主要并发症的差异;(3)观察随访期间两组患者的术后3年生存情况。采用SPSS 25.0统计软件进行数据分析,生存曲线采用Kaplan-Meier并行Log-Rank检验。结果PSM后两组患者基线资料差异均无统计学意义(P>0.05)。两组患者手术时间、术中出血量、术中输血人数、淋巴结清扫数量,以及术后排气时间差异无统计学意义(P>0.05),高龄糖尿病组术后进入ICU治疗人数高于非高龄非糖尿病组,差异有统计学意义(χ^(2)=4.04,P=0.042)。在术后并发症发生率方面,两组差异无统计学意义[34.6%(36/104)比25.0%(26/104),χ^(2)=2.30,P=0.130];但按照Clavien-Dindo外科并发症分级,高龄糖尿病组术后Clavien-DindoⅢ级并发症发生率高于非高龄非糖尿病组[12.5%(13/104)比4.8%(5/104),χ^(2)=3.89,P=0.049]。手术局部并发症方面,高龄糖尿病组术后吻合口漏发生率高于非高龄非糖尿病组(χ^(2)=4.70,P=0.030);两组患者术后伤口感染率差异无统计学�Objective To investigate the outcome after laparoscopic radical surgery for colorectal cancer in patients over 80 years of age with preoperative combined type 2 diabetes(T2DM).Methods Clinical data of 919 patients who underwent colorectal cancer laparoscopic resection surgery in Shaanxi Provincial People′s Hospital from January 2015 to January 2019 were retrospectively analyzed.The propensity score matching(PSM)method was used for 1∶1 matching of gender,ASA score,preoperative serum albumin level,body mass index(BMI),preoperative haemoglobin level,clinical tumour pathology TNM staging,tumour location,other medical comorbidities and history of abdominal surgery and finally group of 104 elderly diabetic patients aged≥80 years with combined T2DM were successfully matched with another 104 non-elderly non-diabetic patients<80 years without combined diabetes group.(1)To compare the differences in operating time,intraoperative bleeding,number of intraoperative blood transfusions,number of lymph nodes dissected,number of ICU treatments,postoperative time to exhaustion and postoperative hospital stay,and postoperative adjuvant chemotherapy between the two groups after matching.(2)To observe the difference in major postoperative complications between the two groups.(3)Patients in both groups were observed for three years post-operative survival rate during the follow-up period.SPSS 25.0 statistical software was used for data analysis.The survival analysis was carried aut by the Kaplan-Meier curve method in parallel and the Log-Rank test.Results Both groups were balanced in terms of baseline variable after PSM(P>0.05).There was no difference between the two groups in terms of operative time,intraoperative bleeding,number of intraoperative blood transfusions,number of lymph nodes dissected,or time to postoperative evacuation(P>0.05).There was a statistically significant difference between two groups in the number of people admitted to the ICU for treatment(χ^(2)=4.04,P=0.042),and≥80 years diabetic group was higher.Th

关 键 词：糖尿病 2型 结直肠肿瘤 外科手术 80岁及以上的老年人 手术后并发症 Clavien-Dindo分级 生存率 

分 类 号：R587.1[医药卫生—内分泌] R735.34[医药卫生—内科学]