高龄患者腹腔镜结直肠切除术安全性的研究

目的:评价为高龄患者行腹腔镜结直肠切除术的安全性及可行性。方法:回顾分析2003年8月至2008年8月我院择期行结直肠切除术中大于等于70岁高龄患者的临床资料。比较同期56例腹腔镜结直肠切除术和52例开腹手术患者的一般情况、疾病分类、手术指标、术后恢复情况和治疗效果。患者平均年龄开腹组74岁,腹腔镜组73岁。两组患者术前合并症、美国麻醉师协会术前危险度评分、疾病类型均无显著差异。结果:平均手术时间开腹组192min,腹腔镜组187min,P=0.616。开腹组术中平均出血218ml,腹腔镜组约86ml,P=0.000。腹腔镜组1例中转开腹。两组均无死亡病例。肠功能恢复时间开腹组5d,腹腔镜组3d,P=0.000。进流食时间开腹组5d,腹腔镜组4d,P=0.026。平均住院时间开腹组22d,腹腔镜组18d,P=0.000。术后心肺并发症发生率开腹组26.9%,腹腔镜组10.7%,P=0.030。结论:为高龄患者行腹腔镜结直肠切除术安全可行,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,缩短住院时间等。

Evaluation on safety of laparoscopic colorectal resection in elderly patients

Objective:To evaluate the feasibility and safety of elderly patients(aged 70 and above) who underwent laparoscopic colorectal resection.Methods:Consecutive patients aged 70 and above who had elective colorectal resection from Aug.2003 to Aug.2008 were analyzed retrospectively.Data concerning demography,classification of diseases,details of operations,and postoperative recovery were compared between laparoscopic surgery and open surgery.Results:Fifty-six patients had laparoscopy and 52 had open surgery during the study period.Average ages were 74 years and 73 years in the open and laparoscopic groups,respectively.No significant difference was found among presence of premorbid comorbidities,American Society of Anesthesiology score,and incidence of previous surgery in the two groups.Average operative time was similar(187 minutes versus 192 minutes,P=0.616),but blood loss was less(86ml versus 218ml,P=0.000) in the laparoscopic group.Conversion to open surgery occurred in one patient.No patient died in both groups.Laparoscopic resection was associated with earlier return of bowel function(3 days versus 5 days,P= 0.000),earlier resumption of liquid diet(4 days versus 5 days,P=0.026),shorter hospital stay(18 days versus 22 days,P= 0.000),and less cardiopulmonary morbidity(10.7% versus 26.9%,P=0.030) when compared with open colorectal resection.Conclusions:With decreased intraoperative blood loss,less postoperative cardiopulmonary complications,faster gastrointestinal functional recovery and shorter hospital stay,laparoscopic colorectal resection offers a safe option for elderly patients.