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目的探讨腹腔镜结直肠手术治疗70岁以上老年人结直肠肿瘤的安全性与有效性。方法回顾性总结2003年1～10月腹腔镜辅助与开腹结直肠手术治疗70岁以上老年人结直肠肿瘤的经验。同期比较腹腔镜手术(LAP组)30例与传统开腹手术(OPEN组)71例的手术安全性、并发症、术后恢复情况。结果LAP组无手术相关死亡病例,OPEN组有2例(2.8%)分别因为术后肺部感染与吻合口瘘而死亡。两组病人随年龄增加ASA(americansocietyofanesthesiologyscore)分级增高。OPEN组有29例(40.8%)发生术后并发症显著多于LAP组6例(20.0%)(P<0.05)。LAP组病人术中出血、排气时间与进食半流质时间分别为(91.7±49.9)mL、(2.3±1.2)d与(4.9±1.8)d,与OPEN组(156.3±118.8)mL、(3.4±2.9)d与(5.8±1.2)d相比差异有显著性意义(P<0.05)。两组手术时间与住院天数差异无统计学意义(P>0.05)。结论腹腔镜结直肠手术治疗70岁以上老年人结直肠肿瘤安全有效,值得进一步推广应用。
Objective To investigate the safety and efficacy of laparoscopic colorectal surgery in the treatment of colorectal cancer in the elderly over 70 years old. Methods The clinical experience of laparoscopic assisted and open colorectal surgery for colorectal cancer in the elderly over 70 years old from January to October in 2003 was retrospectively reviewed. During the same period, the safety, complications and postoperative recovery of 30 patients with laparoscopic surgery (LAP group) and 71 patients with open laparotomy (OPEN group) were compared. Results There were no surgical related deaths in LAP group. Two patients (2.8%) in OPEN group died of postoperative pulmonary infection and anastomotic fistula, respectively. Two groups of patients with age increased ASA (americansocietyofanesthesiologyscore) grading. Twenty-nine patients (40.8%) in the OPEN group had significantly more postoperative complications than those in the LAP group (6%, 20.0%, P <0.05). The duration of bleeding, excretion time and half-life of patients in LAP group were (91.7 ± 49.9) mL, (2.3 ± 1.2) d and (4.9 ± 1.8) d respectively, which were significantly higher than those in OPEN group (156.3 ± 118.8) mL and ± 2.9) d and (5.8 ± 1.2) d, the difference was significant (P <0.05). There was no significant difference between the two groups in operation time and hospitalization days (P> 0.05). Conclusions Laparoscopic colorectal surgery is safe and effective in the treatment of colorectal cancer in the elderly over 70 years old. It is worth further promotion and application.