高龄患者腹腔镜辅助结直肠癌切除术的临床疗效

目的:探讨高龄患者(≥70岁)行腹腔镜辅助结直肠癌切除术的安全性和有效性。方法:根据纳入与排除标准,前瞻性纳入2012年1月―2015年1月收治的高龄结直肠癌患者120例,将患者随机分为腹腔镜组和开腹手术组,每组60例,分别行腹腔镜辅助结直肠癌切除术和开腹结直肠癌切除术。比较两组患者的相关临床指标。结果:与开腹组比较,腹腔镜组手术时间(118.23min vs.120.85min,P=0.458)与淋巴结清扫数目(18.12枚vs.17.37枚,P=0.218)无统计学差异,但术中出血量明显减少(307.28mL vs.354.80mL,P=0.000)、术后排气时间明显缩短(38.27h vs.47.02h,P=0.000)、住院时间明显缩短(16.58d vs.20.07d,P=0.000)。两组患者肠瘘、皮下感染、吻合口瘘、肠梗阻、尿路感染和肺部感染发生率差异均无统计学意义(均P0.05)。两组患者术后24个月时复发率(35.0%vs.41.7%,P=0.453)与病死率(13.3%vs.18.3%,P=0.453)差异均无统计学意义。结论:高龄患者行腹腔镜辅助结直肠癌切除术安全有效,值得进一步推广。     

高龄胃癌患者腹腔镜胃切除术安全性与近期疗效

目的:评价为高龄胃癌患者行腹腔镜胃切除术的安全性及近期疗效.方法:回顾分析2008年7月-2011年12月87例行胃切除术高龄(≥70岁)胃癌患者的临床资料,其中39例行腹腔镜手术(腔镜组),48例行开腹手术(开腹组),比较两组患者的一般情况、手术指标、术后恢复情况、并发症情况及治疗效果.结果:两组患者性别、中位年龄、术前合并症、ASA术前危险度评分、疾病类型均无明显差异(均P＞0.05).与开腹组比较,除平均手术时间无明显差异外(P＞0.05),腔镜组术中平均出血量(73 mL vs.309 mL),肠功能恢复时间(4.1 d vs.5.5 d),进流食时间(4.2 d vs.6d),平均住院时间( 19.1 d vs.25.2 d),术后心肺并发症发生率(28.2％ vs.56.3％)均明显减少(均P＜0.05).平均随访29个月,腹腔镜组和开腹组患者总生存率分别是57.1％和65.9％ (P＞0.05).结论:为高龄患者行腹腔镜胃癌切除术安全可行,可减少患者术中出血量,降低术后心肺并发症的发生率,加快术后胃肠功能恢复.     

70岁以上老年患者腹腔镜结直肠手术66例临床分析

目的 探讨腹腔镜结直肠切除术对70岁以上老年患者的可行性及临床效果.方法 回顾分析我院2010年3月至2012年8月对66例70岁以上的老年患者行腹腔镜结直肠切除术的临床资料.结果 59例顺利完成腹腔镜手术,中转开腹手术7例.平均手术时间为228min,术中平均出血量约132ml,肠功能恢复平均时间为4d,进食流食时间平均为5d,住院时间平均为18d,术后10d内有20例患者出现并发症,其中发生肺部感染9例,急性冠脉综合征2例,肠梗阻2例,吻合口瘘1例,尿潴留6例.无术中、术后死亡病例.结论 老年患者腹腔镜下结直肠切除术创伤小,安全可行,是较理想的手术方式.近期疗效较好,远期疗效有待观察.     

腹腔镜辅助下结直肠手术初探

目的:探讨腹腔镜技术在结直肠手术中的应用价值。方法:腹腔镜辅助下行结直肠手术6例,其中乙状结肠癌根治术2例,直肠中上段癌行直肠前切除术(Dixon术式)3例,直肠下段癌行经腹会阴联合直肠切除术(Mile’s术式)1例。结果: 4例手术获成功, 2例中转开腹,无死亡病例,手术平均时间200min,术中平均失血60ml( 40 ~100ml),术后2 ~4d(平均2 4d),肠蠕动恢复。结论:腹腔镜辅助下的结直肠手术具有患者创伤小,胃肠道功能干扰少,康复快等优点,安全可行。严格掌握手术适应证和充分准备术前各种仪器设备是完成此类手术的关键。     

腹腔镜保肛全直肠系膜切除术治疗直肠癌的临床分析

目的 探讨腹腔镜保肛全直肠系膜切除术治疗直肠癌的手术方法及近期疗效.方法 回顾性分析2010年6月至2013年1月间30例直肠癌患者行腹腔镜保肛全直肠系膜切除术（腹腔镜组）,与同期32例直肠癌行开腹直肠前切除术（开腹组）作对照.结果 腹腔镜组术中失血（151.8±19.2）ml,明显少于开腹组（236.5±43.9） ml,P=0.000;手术时间腹腔镜组为（236.7±16.2）min,长于开腹组的（195.9±10.9）min,P=0.000;腹腔镜组肠道功能恢复为（2.4±0.6）d,早于开腹组的（2.9±0.5）d,P=0.001;且住院时间短（P=0.000）;腹腔镜组总并发症发生率低于开腹组[6.7％（2/30）、31.3％（10/32）,P=0.014,腹腔镜组吻合口漏1例、肠梗阻1例,开腹组吻合口漏2例、肠梗阻3例,开腹组切口感染2例、切口裂开和切口疝各1例,术后发生肺不张1例;腹腔镜组清扫淋巴结数目为（11.95±1.73）枚,开腹组为（11.65±1.40）枚（P=0.465）;肿瘤距下切缘距离腹腔镜组为（4.46±1.19） cm,开腹组为（4.58±0.68） cm（P=0.647）;下切缘阴性率均为100％,术后病理分期及生存时间两组间差异均无统计学意义（P＞0.05）,但腹腔镜组住院费用仍较高（P＜0.01）.结论 腹腔镜保肛全直肠系膜切除术治疗直肠癌创伤小、出血少、恢复快、并发症发生率低,根治效果与开腹术一样彻底,但住院费用高于开腹组,手术时间在学习曲线内长于开腹组.     

腹腔镜辅助全结直肠切除术治疗家族性腺瘤性息肉病9例报告

目的:探讨腹腔镜辅助全结直肠切除术治疗家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)的安全性、可行性及应用价值。方法:回顾分析为9例FAP患者行腹腔镜辅助全结直肠切除术的临床资料,总结手术经验,并观察其安全性、术后患者康复情况及短期随访结果。同期5例开腹全结直肠切除术患者作为对照组。结果:9例患者均顺利完成手术,无中转开腹及术中并发症发生;手术时间160～250 min,平均195.56 min,略长于开腹组;术中出血量50～300 ml,平均138.89 ml,与开腹组相比,差异无统计学意义;切口长度4～6 cm,平均5.11 cm,术后肠功能恢复时间2～4 d,平均2.78 d,显著优于开腹组;术后住院7～20 d,平均12.11 d,与开腹组差异无统计学意义。术后1例低位吻合患者出现吻合口漏,余均无严重并发症发生。随访7～40个月,无肿瘤局部复发、远处转移及死亡。结论:具有丰富的腹腔镜及开腹手术经验的术者行腹腔镜辅助全结直肠切除术安全、可行,患者创伤小,康复快,近期效果良好,但尚需进一步的病例积累及随机对照研究。     

腹腔镜与开腹肠粘连松解术的对比研究

目的比较腹腔镜与开腹肠粘连松解术的临床效果. 方法回顾性分析1999年12月～2002年12月我院25例粘连性肠梗阻行腹腔镜肠粘连松解术(腹腔镜组)的临床资料,与同期开腹肠粘连松解术23例(开腹组)对比,比较两组手术时间、术中出血量、手术并发症发生率、术后肠道功能恢复时间及住院时间. 结果腹腔镜组23例手术成功, 2例中转开腹, 腹腔镜组与开腹组手术时间分别为(58.3±8.1) min和(84.0±7.5) min(t=11.383,P=0.000);术中出血量分别为(31.4±5.1) ml和(192.6±26.4) ml(t=29.995,P=0.000);术后住院时间分别为(4.1±1.4) d和(9.7±2.0) d(t=11.413,P=0.000);术后肠道功能恢复时间分别为(19.6±2.2) h和(49.0±8.8) h(t=16.207,P=0.000);术后并发症分别为1例和9例(χ2=6.960,P=0.008).结论腹腔镜肠粘连松解术与开腹手术相比,具有手术时间短、出血少、术后恢复快和并发症少等优点.     

腹腔镜结直肠肿瘤手术69例报告

目的:探讨腹腔镜手术治疗结直肠肿瘤的临床应用价值。方法:回顾分析为69例结直肠肿瘤患者行腹腔镜辅助手术的临床资料。结果:67例顺利完成腹腔镜手术,手术时间平均(135.3±47.4)min,术中出血量平均(126.8±35.9)ml,术后平均住院(9.3±2.1)d,术后无严重并发症发生,短期肿瘤无复发。结论:腹腔镜结直肠手术具有患者创伤小、术后肠道功能恢复快、住院时间短、腹壁疤痕小等优点。对于恶性肿瘤,腹腔镜手术同样可达到开腹手术的根治目的,且复发率、生存率与开腹手术无明显差异。     

腹腔镜结直肠手术的临床应用

目的总结腹腔镜结直肠手术的临床应用经验. 方法运用腹腔镜技术,按开放手术原则治疗结直肠癌32例,其中右半结肠切除术2例,乙状结肠切除术2例,直肠癌行直肠前切除术(Dixon术式)19例,Miles术式9例. 结果 31例手术成功,1例上段直肠癌因侵及膀胱后壁中转开腹手术.手术时间110～210 min,平均160 min.术中出血量40～300 ml,平均150 ml.术后1～3 d肠蠕动恢复,平均1.6 d.无术后出血、吻合口漏、尿潴留等并发症,2例术后性功能障碍.术后住院5～8 d,平均7 d.随访32例,时间1～18个月,平均6个月,1例腹腔内广泛转移. 结论腹腔镜结直肠手术安全可行.严格掌握手术适应证、熟练的腹腔镜手术技术和丰富的开腹结直肠手术经验是完成此类手术的关键.     

基层医院开展腹腔镜结直肠手术的体会(附10例报告)

目的:探讨基层医院开展腹腔镜结直肠癌手术的可行性和安全性。方法:2006年6月至11月我院为10例患者行腹腔镜结直肠癌手术,其中乙状结肠切除术3例,Dixon手术5例,Miles手术2例。结果:10例均顺利完成手术,平均手术时间210min,术中平均出血180ml,术后肠道功能恢复时间平均28h,术后平均住院9d,淋巴结清扫数5~16枚。无手术死亡、中转开腹及并发症发生。结论:腹腔镜治疗结直肠癌具有创伤小,出血少,肠功能恢复快,住院时间短,术后并发症少等优点。只要能熟练掌握结直肠解剖特性,开展腹腔镜结直肠癌手术是安全可行的。     

Laparoscopic colorectal resection: a safe option for elderly patients

BACKGROUND: Open colorectal surgery in the elderly has been associated with higher morbidity and mortality rates. The favorable short-term outcomes of laparosocopic colorectal resection might reduce the morbidity in elderly patients. This study compares results of elderly patients (aged 70 and above) who underwent laparoscopic colorectal resection with those having open surgery. STUDY DESIGN: Consecutive patients aged 70 and above who had elective colorectal resection from June 2000 to December 2001 were included. Data concerning demographics, diseases, details of operations, and postoperative events were collected prospectively. Comparisons between results of laparoscopic surgery and open surgery were made. RESULTS: Sixty-five patients had laparoscopic colectomy and 89 had open surgery during the study period. Median ages were 77 years and 75 years in the open and laparoscopic groups, respectively. Presence of premorbid medical conditions, American Society of Anesthesiology score, and incidence of previous surgery were similar in the two groups. Median operative time was longer (180 minutes versus 135 minutes, p < 0.001), but blood loss was less (100 mL versus 200 mL, p = 0.001) in the laparoscopic group. Conversion to open surgery occurred in eight patients. One patient died in the laparoscopic group and five died in the open group. Laparoscopic resection was associated with earlier return of bowel function (3 days versus 4 days, p = 0.004), earlier resumption of solid diet (3 days versus 5 days, p < 0.001), shorter hospital stay (7 days versus 9 days, p = 0.001), and less cardiopulmonary morbidity (7.7% versus 22.4%, p = 0.033) when compared with open colorectal resection. CONCLUSIONS: Laparoscopic colorectal resection is a safe option for elderly patients and is associated with more favorable short-term outcomes in terms of earlier return of bowel function, earlier resumption of diet, and shorter hospital stay. It is also associated with less cardiopulmonary morbidity, which is an important complication after colorectal surgery in the elderly.     

A prospective case-matched comparison of clinical and financial outcomes of open versus laparoscopic colorectal resection

Background We aimed to assess the clinical outcomes and costs associated with laparoscopic resection within an elective colorectal practice. Method Over a 12-month period data were prospectively collected on patients undergoing elective colorectal resection under the care of a single consultant surgeon. Thirty patients undergoing laparoscopic colorectal resection were case-matched by type of resection, disease process, and, where appropriate, cancer stage to patients having open surgery. A cost analysis was carried out incorporating cost of surgical bed stay, theater time, and specific equipment costs. Results In the 30 patients having laparoscopic resection, a conversion rate of 13% was observed. Surgery was performed for colorectal cancer in 83% of patients, and 53% of resections were rectal. No significant differences were found in age (65 versus 69 years, p = 0.415), BMI (27.4 versus 26.1, p = 0.527), POSSUM physiology score (16 versus 16.5, p = 0.102), American Society of Anesthesiologists (ASA) grade (2 versus 2, p = 0.171), or length of theater time (160 min versus 160 min, p = 0.233) between the laparoscopic and open patients. Hospital stay was reduced in the laparoscopic group (5 versus 9 days, p < 0.001). Average cost of surgical equipment used for a laparoscopic resection was greater than for open surgery (￡912.39 versus ￡276.41, p = 0.001). Cost of hospital stay was significantly less (￡1259.75 versus ￡2267.55, p < 0.001). Cost of operating room time was similar for the two groups (￡2066.63 versus ￡1945.07, p = 0.152). Overall no significant cost difference could be found between open and laparoscopic resection (￡4560.9 versus ￡4348.45, p = 0.976). More postoperative complications were seen in the open resection group (14 versus 4, p < 0.001). Conclusions Intraoperative equipment costs are greater for laparoscopic resection than for open surgery. However, benefits can be seen in terms of quicker recovery and shorter hospital stay. Laparoscopic surgery is a financially viable alternative to open resection in selected patients.     

Laparoscopic colorectal surgery in elderly patients: a matched case-control study in 178 patients

BACKGROUND: We conducted a prospective case-matched study to compare outcomes of laparoscopic colorectal surgery in elderly (>or= 70 years) and younger (< 70 years) patients. STUDY DESIGN: Among 506 consecutive patients who underwent 536 colorectal resections supervised by 1 colorectal surgeon (YP), 75 elderly patients (>or= 70 years)were matched with 103 younger patients (< 70 years), according to gender, body mass index, pathology, and surgical procedure. Postoperative mortality and morbidity were defined as in-hospital deaths and complications. RESULTS: One hundred seventy-eight patients (95 men and 83 women) underwent laparoscopic colorectal resection for colorectal carcinoma (40%) or benign diseases (60%). Laparoscopic surgical procedures included left colectomy (43%), rectal resection (34%), right colectomy (12%), subtotal colectomy (6%), and rectopexy (5%). Cardiopulmonary comorbidities were significantly more frequent in elderly compared with young patients (80% versus 33%, p < 0.001). Mean operating times were similar between elderly and young patients (244+/-89 minutes versus 242+/-80 minutes, NS). Thirty-two patients (18%, 16 in each group) required conversion to laparotomy. There was no mortality. Overall postoperative complications were comparable between groups (32% versus 26%, NS). Sixteen patients (9%, 5 elderly and 11 young) required reoperation. Mean hospital stay was comparable between groups (11+/-8 days versus 10+/-9 days, NS). CONCLUSIONS: This large case-matched study suggested that laparoscopic colorectal surgery may be proposed in elderly patients, with similar postoperative outcomes as this surgery has in young patients, despite significantly more frequent cardiorespiratory comorbidities.     

腹腔镜与开腹手术在老年结直肠癌患者中的应用分析

目的 比较腹腔镜与开腹手术对70岁以上老年结直肠癌患者的近期疗效,并评价腹腔镜手术的安全性和可行性.方法 回顾分析2009年1月-2015年12月仪征市人民医院普外科收治的91例行腹腔镜与开腹手术的70岁以上老年结直肠癌患者的临床资料,其中腹腔镜组38例,开腹组53例.比较两组的手术学指标、术后恢复及并发症发生情况等.数据比较采用t检验、Mann-WhitneyU检验、Pearson x2检验或Fisher确切概率检验.结果 两组患者的年龄、性别、ASA评分、既往腹部手术史、病理分期及慢性合并症构成差异无统计学意义.两组均无死亡病例.腹腔镜组38例,1例(2.1％)因右侧输尿管损伤中转开腹行输尿管修补吻合+双“J”管置入术,传统开腹组53例.腹腔镜组和开腹组手术时间(238 ±71.3) minvs(175±60.8) min、术中出血量(145 ±58) ml vs (186 ±45) ml比较,差异均具有统计学意义(P＜0.05).淋巴结清扫数目(11.6±2.8)枚vs(13.1±3.0)枚,P=0.513,差异无统计学意义,所有标本切缘病理检查均为阴性.腹腔镜组术后首次下床活动时间(2.1±1.7)dvs(2.9±0.8)d、肠功能恢复时间(3.6±0.5)dvs(4.1±0.6)d、进食流质时间(3.3±0.3)dvs(3.9±0.6)d、术后住院时间(11.9±3.9) dvs (14.5±3.7)d,均显著低于开腹组(P＜0.05).术后总并发症23.7％,显著低于开腹组45.3％ (P =0.035);切口感染也显著降低(P=0.017).术中并发症以及术后吻合口瘘、吻合口出血、尿路感染、肺部感染、腹腔感染、肠梗阻、淋巴漏、心律失常、谵妄发病率两组差异均无统计学意义(P＞0.05).结论 老年结直肠癌患者实施腹腔镜手术是安全可行的,近期疗效优于开腹手术.     

Ultrasonic versus standard electric dissection in laparoscopic colorectal surgery: a prospective randomized clinical trial

OBJECTIVE: To assess the safety and efficacy of the ultrasonic dissection (UC) compared with standard electrosurgery (ES) in laparoscopic colorectal surgery. BACKGROUND DATA: High-frequency ultrasound energy was introduced in laparoscopic surgery to improve dissection and coagulation. Very limited data have been published on its use in laparoscopic colorectal surgery. METHODS: Patients eligible for elective laparoscopic right or left hemicolectomy (RH and LH), sigmoidectomy (SG), or low anterior resection (LAR) were randomized to either UC or ES. The following data were collected and analyzed: preoperative data (individual patient data, indication for surgery), intraoperative data (conversion to open surgery, conversion ES to UC, operative time, blood loss, complication rate), and postoperative data (morbidity and mortality, volume of drainage, hospital stay). RESULTS: Between January 2002 and December 2003, 171 patients underwent elective laparoscopic colorectal resection. Twenty-5 patients did not satisfy the inclusion criteria and were excluded. The diagnosis of the remaining 146 patients was diverticulitis (44), colonic adenoma (31), adenocarcinoma (70), or epidermoid carcinoma (1). These patients underwent laparoscopic RH (28), LH (31), SG (47), or LAR (40). There were no differences in preoperative data. The overall conversion rate to open surgery was 11.6%, with no differences between the two groups; 20.8% undergoing ES were converted to UC, more frequently during right hemicolectomy or low anterior resection. Operative time, the primary endpoint of this study, did not differ between the two groups: UC 93 minutes versus ES 102.6 minutes (P = 0.46). Intraoperative blood loss was significantly less in UC 140.8 mL versus ES 182.6 mL (P = 0.032). No differences were observed in postoperative morbidity or other preoperative or postoperative parameters. CONCLUSIONS: UC is a useful device in laparoscopic colorectal surgery that facilitates completion of difficult cases and reduces intraoperative blood loss. Nevertheless, the majority of laparoscopic procedures can be completed with ES. Therefore, selective use of UC appears to be the most cost-effective policy.     

Laparoscopic-assisted versus open ileocolic resection for Crohn's disease: a randomized trial

OBJECTIVE: The aim of the study was to compare laparoscopic-assisted and open ileocolic resection for primary Crohn's disease in a randomized controlled trial. METHODS: Sixty patients were randomized for laparoscopic-assisted or open surgery. Primary outcome parameter was postoperative quality of life (QoL) during 3 months of follow-up, measured by SF-36 and GIQLI questionnaire. Secondary parameters were operating time, morbidity, hospital stay, postoperative morphine requirement, pain, and costs. RESULTS: Patient characteristics were not different. Conversion rate was 10% (n=3). Median operating time was longer in laparoscopic compared with open surgery (115 versus 90 minutes; P<0.003). Hospital stay was shorter in the laparoscopic group (5 versus 7 days; P=0.008). The number of patients with postoperative morbidity within the first 30 days differed between the laparoscopic and open group (10% versus 33%; P=0.028). There was no statistically significant difference in QoL between the groups during follow-up. Significant time effects were found on all scales of the SF-36 (P<0.001) and the GIQLI score (P<0.001). QoL declined in the first week, returned to baseline levels after 2 weeks, and was improved 4 weeks and 3 months after surgery. Median overall costs during the 3 months follow-up were significantly different: euro6412 for laparoscopic and euro8196 for open surgery (P=0.042). CONCLUSIONS: Although QoL measured by SF-36 and GIQLI questionnaires was not different for laparoscopic-assisted compared with the open ileocolic resection, morbidity, hospital stay, and costs were significantly lower.     

肝脏肿瘤的微创治疗——从腹腔镜到机器人

目的探讨完全腹腔镜、手助式腹腔镜及机器人三种微创手术方式在肝脏切除术中的可行性、安全性及适用范围。方法回顾性分析上海交通大学医学院附属瑞金医院普外科自2004年9月至20l2年1月期间完成的微创肝脏切除术(minimally invasive liver resection,MILR)128例患者的临床资料,根据手术方式分为完全腹腔镜肝脏切除术(pure laparoscopic resection,PLR)组、手助式腹腔镜肝脏切除术(hand-assisted laparoscopicresection,HALR)组及机器人辅助肝脏切除术(robotic liver resection,RLR)组,分别观察3组患者术中与术后恢复情况并进行对比分析。结果 PLR组82例,中转开腹3例,手术时间为(145.4±54.4)min(40～290 min)、术中出血量为(249.3±255.7)ml(30～1 500 ml),术后并发腹腔感染3例,胆瘘5例,经保守治疗后痊愈,无围手术期死亡,术后住院时间为(7.1±3.8)d(2～34 d)。HALR组35例,中转开腹3例,手术时间为(182.7±59.2)min(60～300 min)、术中出血量为(754.3±785.2)ml(50～3 000 ml),术后并发腹腔感染1例,胆瘘2例,切口感染2例,经保守治疗后痊愈,无二次手术,术后住院时间为(15.4±3.7)d(12～30 d)。RLR组11例,中转开腹2例,手术时间为(129.5±33.5)min(120～200 min)、术中出血量为(424.5±657.5)ml(50～5 000 ml),术后并发腹腔感染1例,胆瘘1例,经保守治疗后痊愈,术后住院时间为(6.4±1.6)d(5～9 d)。3组中,RLR组手术时间最短(P=0.001),术后住院时间最短(P=0.000),PLR组术中出血量最少(P=0.000),其差异均有统计学意义。结论肝脏肿瘤微创切除术安全、可行,临床工作中,需要根据不同的病例选择不同的手术方式。机器人辅助肝脏切除术为肝脏肿瘤的微创治疗带来了新的突破。     

中晚期结直肠癌191例腹腔镜与开腹根治术的疗效比较

目的比较分析应用腹腔镜下进展期结直肠癌根治术的可行性、肿瘤根治性及临床疗效。方法分析广东省人民医院2006年6月至2007年12月收治的191例进展期结直肠癌患者的临床资料。结果根据随机数字表进行分组,98例接受腹腔镜手术,93例接受传统开腹手术。腹腔镜手术组中5例（5．1％）中转开腹手术。腹腔镜手术组术中出血量为（87．2±27．1）ml,明显少于传统开腹手术组的（279．5±189．4）ml（P=0．011）。腹腔镜手术组48h内肛门排气和离床活动的患者分别占37．8％（37／98）和30．6％（30／98）,明显高于传统开腹手术组的6．5％（6／93,P=0．000）和3．2％（3／93,P=0．000）。传统开腹手术组术后需要使用麻醉性止痛药止痛的患者占133％（13／98）．明显高于腹腔镜手术组的61．3％（57／93）（P=-0．000）。腹腔镜手术组平均总住院时间为（8．9±5．9）d．明显低于传统开腹手术组（12．1±7．6）d（P=0．036）。两组其他临床因素（性别、年龄、肿瘤部位和TNM分期、手术切除方式、收获淋巴结数目、术后并发症发生率等）比较,差异无统计学意义（P〉0．05）。结论进展期结直肠癌行腹腔镜根治术安全可行．能达到与开腹同样的效果。     

Efficacy of laparoscopic resection in elderly patients with colorectal cancer

Purpose

The perioperative outcomes of laparoscopic colorectal surgery in elderly patients were compared with those of open surgery in elderly patients and those of laparoscopic surgery in nonelderly patients to evaluate the feasibility and efficacy of laparoscopic surgery in elderly patients with colorectal cancer.

Methods

The data of the patients who underwent surgical resection for colorectal cancer between January 2007 and September 2012 were retrospectively collected. The clinical backgrounds and outcomes of elderly patients (≥70 years of age) who underwent laparoscopic surgery (EL group) were compared with those of elderly patients who underwent open surgery (EO group) and those of nonelderly patients (<70 years of age) who underwent laparoscopic surgery (NL group).

Results

Compared with the EO group, the EL group showed significantly less blood loss (15 versus 100 ml), fewer postoperative complications (10.7 versus 36.7 %), earlier resumption of an oral diet (4 versus 5 days) and shorter postoperative hospital stays (16 versus 28 days). A case-matched analysis showed similar results. All perioperative outcomes were equivalent between the EL and NL groups.

Conclusions

Laparoscopic colorectal surgery in elderly patients with cancer was not only superior to open surgery in elderly patients, but also equivalent to laparoscopic surgery in nonelderly patients in terms of the postoperative outcomes.     

Laparoscopic colonic resection in fast-track patients does not enhance short-term recovery after elective surgery

BACKGROUND: Laparoscopic colorectal surgery has been claimed to enhance recovery when compared with open surgery. The aim of our study was to investigate whether laparoscopic colorectal resection improved recovery with the use of a multimodal rehabilitation programme. METHOD: We carried out a prospective audit of 80 patients undergoing elective colorectal resection between November 2003 and March 2005. All patients underwent a fast-track protocol with early feeding, mobilization and a fluid and sodium restriction regime. Recovery was measured in terms of return of gastrointestinal function, hospital stay, complications and quality of life measures. RESULTS: Of the 80 patients in the study 22 underwent laparoscopic resection and 58 had open surgery. Patients were well matched for all baseline characteristics. The groups were not significantly different in terms of opioid or antiemetic use. They were also similar in median time to first flatus (69 h vs 69 h, P = 0.36) and median time to first bowel motion (127 h vs 101 h, P = 0.07). There was no difference in median hospital stay (5.8 days vs 5.9 days, P = 0.87) or complications (P = 0.46) between the laparoscopic and open group. There were no significant differences in Short Form 36 scores between the two groups for any of the components measured. CONCLUSION: Laparoscopic colorectal resection does not appear to reduce the duration of ileus or hospital stay with the use of a multimodal rehabilitation regime. Further large randomized trials are required to confirm these findings.