腹腔镜结直肠癌手术安全性研究进展

1991年Jacobs报道了世界上首例腹腔镜下右半结肠切除术。因腹腔镜结直肠癌手术（laparoscopic colorectal-carcinoma surgcry，LCS）具有损伤小、术后疼痛轻、肠道功能恢复快、能较早进食和恢复活动、不增加围手术期并发症、住院时问短等优点，在世界各地得到迅速发展。目前腹腔镜结直肠癌手术的可行性已得到广泛的认可，但在安全性方面，部分医生及患者尚存疑虑。现对腹腔镜结直肠癌手术安全性研究进展作一综述。     

腹腔镜结直肠癌根治术治疗老年结直肠癌的疗效分析

目的 探讨腹腔镜结直肠癌根治术治疗老年结直肠癌的疗效.方法 将96例老年结直肠癌患者.按照入院顺序抽签后随机分为实验组和对照组,对照组:进行开腹手术治疗.实验组:进行腹腔镜下手术.观察患者手术情况、胃肠功能恢复情况、IL-6、IL-8水平变化情况.结果 实验组手术时间、术中出血量优于对照组,有统计学差异(P＜0.05).两组患者切除标本长度、淋巴结清扫总数对比,无统计学差异(P＞0.05).实验组腹胀持续时间、肛门排气时间短于对照组,有统计学差异(P＜0.05).实验组胃动素、胃泌素水平高于对照组,有统计学差异(P＜0.05).实验组治疗后IL-6水平高于治疗前,低于对照组,有统计学差异(P＜0.05).实验组治疗后IL-8水平低于对照组,有统计学差异(P＜0.05).对照组治疗后IL-6、IL-8水平高于治疗前,有统计学差异(P＜0.05).结论 腹腔镜结直肠癌根治术治疗老年结直肠癌效果较好,患者手术时间、术中出血量低,腹胀持续时间、肛门排气时间短,胃动素、胃泌素水平恢复较好,IL-6、IL-8水平可得到有效改善,临床应用价值较高.     

老年结直肠癌患者腹腔镜手术中快速康复理念应用的价值

目的探讨老年结直肠癌患者腹腔镜手术中快速康复理念应用的价值。方法 2012年1月至2014年1月收治的50例老年结直肠癌患者,依据随机数字表法将分为快速康复组和对照组,每组25例。结果快速康复组患者的下地时间、排气时间、排便时间、饮水时间、住院时间均明显低于对照组(P<0.05),但两组患者的麻醉时间、手术时间、术中出血量、清扫淋巴结数目间的差异均无统计学差异(P>0.05)。快速康复组患者术后并发症发生率为8%(2/25),对照组为28%,差异有统计学意义(P<0.05)。结论老年结直肠癌患者腹腔镜手术中快速康复理念具有较高的应用价值。     

靶向药物在老年晚期结直肠癌患者中的安全性

老年晚期结直肠癌的治疗十分困难。靶向治疗作为晚期结直肠癌的有效治疗手段,在老年患者中的应用日益广泛。靶向药物有其独特的毒副反应,其安全性在老年患者中尚没有充分的证据。该文对现有相关安全性数据作一综述,以期更好地认识相关治疗。     

腔镜与开腹手术治疗老年结直肠癌手术效果及术后并发症

目的:评估70岁以上老年结直肠癌腹腔镜手术外科治疗的安全性、可行性。方法:回顾100例结直肠癌患者,根据手术方式分为腔镜手术(n=50)和开腹手术(n=50)。比较患者手术时间、术中出血量、术后下床时间、清扫淋巴结数目、排便时间、首次流质时间、住院费用、切口长度、排气时间、住院时间及术后并发症等指标。结果:两组患者的手术时间、术中出血量、术后下床时间、清扫淋巴结数目、排便时间、首次流质时间以及住院费用无显著差别（P>0.05）,切口长度、排气时间以及住院时间,腹腔镜组优于开腹组（P<0.05）。各组术后并发症发生率分别为腹腔镜组44%（22/50）,开腹组70%（35/50）,腔镜组患者出现并发症的患者显著少于开腹组（P<0.05）。结论:腹腔镜手术对于老年结直肠癌是安全的,根治性的,术后并发症较少,是老年结直肠癌外科治疗的可靠手术方式。     

腹腔镜与开腹手术在老年结直肠癌治疗中的疗效及安全性分析

目的 探讨腹腔镜与开腹手术在老年性结直肠癌治疗中的疗效及安全性.方法 对进行结直肠癌根治术的老年结直肠癌患者80例进行回顾性分析,按照手术方式不同将其分为观察组43例和对照组37例,观察组患者进行腹腔镜结直肠癌根治术,对照组进行开腹手术.对2组患者围手术期情况、胃肠功能恢复情况、并发症发生情况以及生活质量恢复情况进行观察与比较.结果 观察组患者手术时间及医疗费用较对照组略高,但差异不具有统计学意义(P＞0.05);术中出血量、下床活动时间以及住院时间方面观察组均远远优于对照组,差异有统计学意义(P＜0.05).手术后对照组患者胃动素及胃泌素分泌量均显著下降(P＜0.05),而观察组与术前相比差异不显著(P＞0.05);观察组肠鸣音恢复时间及肛门排气时间均短于对照组,差异有统计学意义(P＜0.05).观察组患者并发症发生率为11.63％,对照组并发症发生率为40.54％,2组差异有统计学意义(P＜0.05).2组患者术后生活质量恢复有效率无统计学差异(P＞0.05),但观察组患者改善率明显高于对照组,差异具有统计学意义(P＜0.05).结论 腹腔镜手术治疗老年结直肠癌具有良好的疗效及安全性,利于胃肠功能及患者生活质量恢复,可作为老年性结直肠癌的临床首选手术方式.     

腹腔镜结直肠癌手术治疗进展

腹腔镜结直肠癌手术开展至今的10余年来,已取得令人瞩目的巨大进步,其手术创伤小、术后恢复快的优势已得到广泛认可,而在手术安全性、可行性、手术后短期疗效等方面也已得到一系列前瞻性随机临床对照研究(RCT)的证实。但作为一种针对恶性肿瘤的治疗方法,其肿瘤根治性、以及与肿     

腹腔镜结直肠癌手术的现状

腹腔镜手术具有切口小、疼痛轻、住院时间短等优点,应用于结直肠手术在技术上被证明是可行的,但是用于结直肠恶性肿瘤切除尚存在争议,主要是人们对手术的安全性和肿瘤的根治效果尚不明确。本文对近几年腹腔镜结直肠癌手术的文献进行综述,了解其手术疗效的初步结果。结论:腹腔镜用于结直肠癌根治经历了“学习曲线”阶段后,手术并发症和病死率与开腹手术相当,现有的回顾性随访资料显示,复发率和生存率与开腹手术相比也无较大差异,但缺少更有说服力的前瞻性临床随机对照研究资料。     

腹腔镜结直肠癌手术的临床研究

目的 评价腹腔镜结直肠癌手术的优点和存在不足之处.方法 对2002年1月至2006年10月完成的22例腹腔镜结直肠癌手术者与同期具可比性的40例传统开腹结直肠癌手术的资料进行比较.结果 腹腔镜组的术中出血量、肠功能恢复时间、尿管留置时间、下床活动时间和人均镇痛次数等均明显少于传统手术组(P＜0.05).腹腔镜组手术时间、手术费和住院总费用等明显多于传统手术组(P＜0.05).两组手术切除的肿块大小、结直肠标本长度、直肠肿瘤远端长度和清扫淋巴结数目的 差异均无统计学意义(P＞0.05).手术并发症发生率分别为9.1%和32.5%,差异有统计学意义(P＜0.05).随访时间6～51个月,两组局部复发率、转移率、病死率均无统计学意义(P＞0.05).结论 腹腔镜结直肠癌根治术可以达到与传统结直肠癌根治术同样的根治效果,具有创伤小、安全、可行的优点.但手术时间较长,费用较高.     

80岁以上高龄结直肠癌患者腹腔镜与开腹手术的近期疗效与远期生存结局分析

目的 探讨80岁以上高龄结直肠癌患者行腹腔镜与开腹手术的近期疗效与远期预后。方法 纳入行根治性手术的80岁以上313例高龄结直肠癌患者,其中开腹组143例、腹腔镜组170例。采用倾向得分匹配平衡两组患者基线资料。Kaplan-Meier绘制生存曲线,Log rank法进行预后比较。Cox比例风险模型分析各因素对总体生存率（OS）和无瘤生存率（DFS）的影响。结果 匹配后,两组各纳入93例患者。腹腔镜组患者平均术中出血量、术后总体并发症与Ⅰ～Ⅱ级并发症发生率低于开腹组（均P<0.05）、术后首次排气时间、经口进食时间与住院时间均明显短于开腹组患者（均P<0.05）、平均淋巴结清扫数量显著多于开腹组（P=0.030）。两组患者有着相似的5年OS(P=0.594)与DFS(P=0.295)。多因素Cox预后分析结果发现CEA水平>5ng/ml、病理TNM分期Ⅲ期与神经侵犯是影响患者不良OS与DFS的独立危险因素。结论 与开腹手术相比,腹腔镜手术可以为80岁以上高龄结直肠癌患者提供更好的短期治疗效果与相似的远期预后。     

S-1 treatment for elderly patients over 75 years with gastric cancer

Background: In our hospital, the starting dose of S-1 for patients over 75 years of age with advanced gastric cancer was determined by body surface of area, creatinine clearance, performance status(PS)and the presence of complications. The objective of this retrospective study was to investigate the proper administration of S-1 in elderly patients by comparing patients given a standard dose of S-1 to those given a reduced dose. Methods: Twenty patients participated. Six patients were administered S-1 at a standard dose(standard group)and fourteen patients with at a reduced dose(reduced group). Safety, feasibility and anti-tumor effects were assessed. Results: Three cases of grade 3 adverse events were found in the standard group, and one case was found in the reduced group. Time to treatment failure was 4. 4 months for the standard group and 8. 2 months for the reduced group. The overall response rate was 25% in the standard group and 30% in the reduced group. Conclusions: It is important to reduce S-1 administration to patients over 75 years of age with caution, and take into account the patient's renal function, PS and Ccr complications.     

Systematic review of laparoscopic vs open surgery for colorectal cancer in elderly patients

AIM: To verify the safety and validity of laparoscopic surgery for the treatment of colorectal cancer in elderly patients. METHODS: A meta-analysis was performed of a systematic search of studies on an electronic database. Studies that compared laparoscopic colectomy (LAC) in elderly colorectal cancer patients with open colectomy (OC) were retrieved, and their short and long-term outcomes compared. Elderly people were defined as 65 years old or more. Inclusion criteria were set at: Resection of colorectal cancer, comparison between laparoscopic and OC and no significant difference in backgrounds between groups. RESULTS: Fifteen studies were identified for analysis. LAC was performed on 1436 patients, and OC performed on 1810 patients. In analyses of short-term outcomes, operation time for LAC was longer than for OC (mean difference = 34.4162, 95%CI: 17.8473-50.9851, P < 0.0001). The following clinical parameters were lower in LAC than in OC: Amount of estimated blood loss (mean difference = -93.3738, 95%CI: -132.3437 to -54.4039, P < 0.0001), overall morbidity (OR = 0.5427, 95%CI: 0.4425-0.6655, P < 0.0001), incisional surgical site infection (OR = 0.6262, 95%CI: 0.4310-0.9097, P = 0.0140), bowel obstruction and ileus (OR = 0.6248, 95%CI: 0.4519-0.8638, P = 0.0044) and cardiovascular complications (OR = 0.4767, 95%CI: 0.2805-0.8101, P = 0.0062). In analyses of long-term outcomes (median follow-up period: 36.4 mo in LAC, 34.3 mo in OC), there was no significant difference in overall survival (mean difference = 0.8321, 95%CI: 0.5331-1.2990, P = 0.4187) and disease specific survival (mean difference = 1.0254, 95%CI: 0.6707-1.5675, P = 0.9209). There was also no significant difference in the number of dissected lymph nodes (mean difference = -0.1360, 95%CI: -4.0553-3.7833, P = 0.9458). CONCLUSION: LAC in elderly colorectal cancer patients had benefits in short-term outcomes compared with OC except operation time. The long-term outcomes and oncological clearance of LAC were similar to that of OC. These results support the assertion that LAC is an effective procedure for elderly patients with colorectal cancer.     

胸腔镜手术应用于75岁以上高龄患者的临床疗效分析

目的探讨75岁以上高龄患者采用胸腔镜手术治疗的安全性和适应证。方法分析2006年1月至2012年10月采用胸腔镜手术治疗的31例75岁以上高龄患者的临床资料,其中肺叶切除+纵隔淋巴结清扫7例,肺楔形切除+区域淋巴结切除9例,肺楔形切除10例,胸膜活检和胸膜腔固定术5例。结果围手术期死亡患者1例。并发症发生率为48.3%(15/31),包括肺部感染、心律失常、肺不张、心脏衰竭和呼吸衰竭等。手术后病理检查16例患者为早期原发性肺癌,其1年生存率和3年生存率分别为91.6%和62.5%。结论对经过选择的75岁以上高龄患者行胸腔镜手术安全可行,其适应证包括早期周围型肺癌、性质未明的孤立性肺周围结节、原因不明或恶性胸腔积液以及为明确病理的单纯活组织检查,而对于早期高龄肺癌患者建议采用肺部分切除+区域淋巴结清扫治疗。     

Concurrent chemoradiotherapy for limited-disease small cell lung cancer in elderly patients aged 75 years or older

Background: The optimal treatment for limited-disease small cell lung cancer(LD-SCLC) in patients aged 75 years or older remains unknown. Methods: Elderly patients with LD-SCLC who were treated with chemoradiotherapywere retrospectively reviewed to evaluate their demographiccharacteristics and the treatment delivery, drug toxicitiesand antitumor efficacy. Results: Of the 94 LD-SCLC patients treated with chemotherapy and thoracicradiotherapy at the National Cancer Center Hospital between1998 and 2003, seven (7.4%) were 75 years of age or older. Allof the seven patients were in good general condition, with aperformance status of 0 or 1. Five and two patients were treatedwith early and late concurrent chemoradiotherapy, respectively.While the four cycles of chemotherapy could be completed inonly four patients, the full dose of radiotherapy was completedin all of the patients. Grade 4 neutropenia and thrombocytopeniawere noted in seven and three patients, respectively. Granulocyte-colonystimulating factor support was used in five patients, red bloodcell transfusion was administered in two patients and platelettransfusion was administered in one patient. Grade 3 or moresevere esophagitis, pneumonitis and neutropenic fever developedin one, two and three patients, respectively, and one patientdied of radiation pneumonitis. Complete response was achievedin six patients and partial response in one patient. The mediansurvival time was 24.7 months, with three disease-free survivorsfor more than 5 years. Conclusion: Concurrent chemoradiotherapy promises to provide long-term benefitwith acceptable toxicity for selected patients of LD-SCLC aged75 years or older.     

Complications after surgery for gastric cancer in patients aged 80 years and over

Recent studies have shown a considerable increase in the number of aged patients with gastric cancer. In this retrospective study, we report our 18-year experience with 110 patients aged 80 years and over affected with this neoplasm. Postoperative morbidity and mortality rates and risk factors affecting their incidence were examined by univariate and multivariate analysis. Operability and resectability rates were 70.9% and 47.3% respectively. Of the resective procedures, 41 (78.8%) were subtotal gastrectomies. In five cases (9.6%), we performed combined resections. Twenty-five patients (32.1%) experienced postoperative complications; overall mortality rate was 12.8% (10 patients). In resective procedures, morbidity and mortality were 26.9% and 3.8% respectively, which are very low rates compared to other Western reports. Statistical analysis identified the number of preexisting medical illnesses as an independent predictor of morbidity and mortality. Crude five-year survival rate of curatively resected cases was 43%. Although multiple medical illnesses involved much higher operative mortality, neither the presence of postoperative complications nor the number of preexisting medical illnesses significantly influenced five-year survival rate of curatively resected patients. With careful evaluation and selection of patients, correct treatment of concomitant diseases and adequate peri- and postoperative care, gastric surgery provides good immediate and long-term results even in very old patients. Subtotal gastrectomy with limited lymphadenectomy should be the preferred procedure; total gastrectomy, combined resections and extended lymphadenectomy should be performed only when necessary, in patients with fewer than two illnesses. Surgery should be avoided in patients with highly advanced disease, if multiple medical illnesses are present.      

70岁以上老年人开胸手术的围手术期处理

目的探讨老年人开胸手术期的处理。方法总结46例70～84岁老年人围手术期的临床经验。结果术后并发心律失常31例,心功能不全7例,腔隙脑梗塞1例,肾功能不全1例,肝功能不全1例,均有不同程度的ALI,其中9例符合ARDS,应用容许性高碳酸血症机械通气治疗而愈。结论老年人开胸手术并存症、并发症高,术前必须最大限度的改善患者的全身情况,对麻醉、手术及术后处理均提出较高要求,尤以心肺并发症为术后防治重点,容许性高碳酸血症机械通气治疗在一定程度上改善了ARDS患者的预后。