合并心血管疾病对80岁以上老年结直肠癌患者围手术期的影响分析*

摘要

Objective: To investigate the effect of comorbid cardiovascular diseases on the perioperative period of colorectal cancer pa-tients aged over 80 years. Methods: Clinicopathological data of 313 elderly patients aged over 80 years who underwent radical surgery for colorectal cancer at Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, from January 2007 to December 2018 were retrospectively collected and analyzed. Propensity score matching was used for 1 : 1 matching of 10 covari-ates. Finally, 128 patients with comorbid cardiovascular diseases were matched with 128 patients without comorbid cardiovascular dis-eases. Perioperative indicators and postoperative complications were compared between the two groups. Result: Both groups were balanced in terms of baseline variables (all P>0.05). In terms of postoperative complications, there was no statistical difference be-tween the two groups [37.5% (48/128) vs . 30.5% (39/128), P=0.235]. According to the Clavien-Dindo classification of postoperative complications, the incidence of postoperative Clavien-DindoⅣcomplications in the comorbid cardiovascular disease group was signifi-cantly higher than that in the non-cardiovascular disease group [7.0% (9/128) vs . 1.6% (2/128), P=0.031]. In terms of local surgical complications, the incidence of postoperative anastomotic leakage in patients with cardiovascular diseases was significantly higher than that in patients without cardiovascular diseases [7.8% (10/128) vs . 2.3% (3/128), P=0.046]. In terms of other local surgical compli-cations, there was no statistical difference between the two groups (all P>0.05). In terms of non-surgical local complications, the inci-dence of postoperative blood circulatory system complications in patients with cardiovascular diseases was significantly higher than that in patients without cardiovascular diseases [10.2% (13/128) vs . 3.1% (4/128), P=0.024]. There was no significant difference in the incidence of other non-surgical local complications between the two groups (all P>0.05). Conclusions: Comorbid cardiovascular diseas-es did not increase the risk of colorectal cancer surgery in patients aged over 80 years. However, it should be noted that the incidence of postoperative blood circulatory system complications and anastomotic leakage is significantly increased in elderly patients with car-diovascular diseases. For such patients, adequate preoperative evaluation, close postoperative monitoring, and the application of pro-tective stoma are key to ensure that elderly patients with colorectal cancer can successfully survive the perioperative period.%目的:探讨术前合并心血管疾病对80岁以上老年结直肠癌患者围手术期的影响.方法:回顾性分析2007年1月至2018年12月在中国医学科学院肿瘤医院行结直肠癌根治手术且年龄≥80岁的313例老年患者的临床病理资料.采用倾向得分匹配法(propensity score matching,PSM)对10个协变量进行1:1匹配,最终128例合并心血管疾病结直肠癌患者与另外128例无心血管疾病结直肠癌患者成功匹配.比较两组间围手术期相关指标与术后并发症等情况.结果:匹配后两组患者基线资料差异均无统计学意义(P>0.05).在术后并发症发生率方面,两组患者间差异无统计学意义[37.5%(48/128)vs . 30.5%(39/128),P=0.235].根据Clavien-Dindo外科手术并发症分级,心血管疾病组患者术后Clavien-DindoⅣ级并发症发生率明显高于无心血管疾病组[7.0%(9/128)vs . 1.6%(2/128),P=0.031].手术局部并发症方面,心血管疾病组患者术后吻合口瘘发生率显著高于无心血管疾病组[7.8% (10/128)vs . 2.3%(3/128),P=0.046],其它手术局部并发症方面两组差异无统计学意义(均P>0.05).非手术局部并发症方面,心血管疾病组患者术后血液循环系统并发症发生率显著高于无心血管疾病组[10.2%(13/128)vs . 3.1%(4/128),P=0.024],其他非手术局部并发症发生率两组间差异无统计学意义(均P>0.05).结论:术前合并心血管疾病不会增加80岁以上老年结直肠癌患者手术的风险.但需注意的是,合并心血管疾病的老年患者术后血液循环系统并发症与吻合瘘的发生率显著升高.针对此类患者,术前充分的评估、术后密切监测以及保护性造口的应用是保证其顺利度过围手术期的关键.