腹腔镜与常规开腹手术治疗老年人乙状结肠癌及直肠癌的临床对比研究

摘要

目的:研究老年人在腹腔镜下行乙状结肠癌及直肠癌根治术的可行性,比较其与常规开腹手术的近期临床效果.方法:185例乙状结肠癌和(或)直肠癌老年患者(年龄>70岁),分为经腹腔镜行根治术组(L组)112例与常规开腹根治术组(O组)73例.L组患者施行腹腔镜下肿瘤根治性切除手术,标本经耻骨联合上横切口取出;O组患者施行常规的过脐正中切口根治手术.比较2组患者的手术时间、清扫淋巴结数、住院费用、疼痛指数、术后消化道功能恢复时间、术后导尿管留置率及术后并发症(切口脂肪液化或感染、吻合口瘘、腹腔脓肿、深静脉血栓、脑部并发症及肺部感染)发生率.结果:2组均无死亡病例,L组无中转手术.L组与O组手术时间分别为(109.7±11.3)min、(121.5±12.2)min;清扫淋巴结数分别为(18.5±2.3)个、(16.6±2.5)个;住院费用分别为人民币(3.57±0.67)万元、(2.98±0.55)万元,P>0.05;疼痛指数分别为3.6±0.6、8.2±1.1;术后消化道功能恢复时间分别为(37.5±6.6)h、(58.3±7.9)h;术后导尿管留置率分别为6.2%、24.6%;术后并发症发生率分别为4.5%和14.9%,(P<0.05).结论:术前经充分准备后,老年患者在腹腔镜下行乙状结肠癌和(或)直肠癌根治术是安全可行的,其近期临床效果优于常规开腹手术.%Objective:To explore the clinical probability of laparoscopic radical resection for senile patients with sigmoid or rectal cancer and compare its short-term effect with the procedure of traditional open operation.Methods: A total of 185 senile patients (age＞70) with sigmoid or rectal cancer were divided into two groups: laparoscopic radical resection group (Group L)112 patients and traditional open radical group (Group O) 73 patients.In Group L, the patients were performed total laparoscopic radical resection for sigmoid or rectum, the sample was taken out from a 4.0cm transverse incision above pubic symphysis.In Group O, the patients were performed traditional open operation.Compared the two groups patients' operation time,number of resected lymph nodes, costs, pain index, time of digestive function recovery, the rate of indwelling catheter and the rate of post-operation complications including incision infection, anastomotic leakage, abdominal abscess, deep vein thrombosis (DVT) and pneumonia.Results: No death cases in two groups, all laparoseopic operations were succeeded in Group L.In Group L and Group O, operation time were 109.7 ± 11.3 min and 121.5 ± 12.2 min, number of resection lymph nodes were 18.5±2.3 and 16.6±2.5, costs were 3.57±0.67 and 2.98±0.55 ten thousand yuan, P＞0.05.Pain index were 3.6±0.6 and 8.2± 1.1, time of digestive function recovery were 37.5 ± 6.6 h and 58.3 ± 7.9 h, the rate of indwelling catheter were 6.2％ and 24.6％, the rate of complications were 4.5％ and 14.9％ (P＜0.05).Conclusions: After proper preparation, performing laparoscopic radical resection for senile patients with sigmoid or rectal cancer is probable available and safe.When compared with traditional open procedure it presents more predominances.