腹腔镜治疗大于75岁T_4分期直肠癌患者的临床价值

目的探讨腹腔镜在治疗大于75岁T4分期直肠癌患者的临床价值。方法分析2008年1月至2012年12月69例直肠癌患者的临床资料,据手术方式不同分组。腹腔镜辅助直肠癌根治术36例(腔镜组),传统开腹手术33例(开腹组)。结果两组切口长度、术中出血量、进食时间、术后住院天数比较差异有统计学意义(P0.05),腔镜组较优;手术时间比较差异无统计学意义(P0.05)。腔镜组并发症发生率25.00%,传统组48.48%,比较差异有统计学意义(P0.05);腔镜组与手术直接相关并发症发生率8.33%,传统组12.12%,比较差异无统计学意义(P0.05);腔镜组与感染相关并发症发生率13.89%,传统组36.36%,比较差异有统计学意义(P0.05);腔镜组围手术期死亡率2.78%,开腹组6.06%,比较差异无统计学意义(P0.05)。标本切缘阴性,远切缘长度比较差异无统计学意义(P0.05),切除淋巴结的总数比较差异有统计学意义(P0.05)。两组1、3年生存率比较差异无统计学意义(P0.05)。结论腹腔镜手术治疗大于75岁高龄T4分期直肠癌患者是安全可行的。

Clinical value in treatment of advanced rectal cancer of stage T4 in patients older than 75 by laparoscopic operation

Objective To investigate the clinical effect on rectal cancer of stage T4 in patients old than 75 by laparoscopy. Methods The clinical data of 69 cases with advanced rectal cancer of stage T4, between January 2008 and December 2012, was analyzed. The patients were randomly divided into two groups according to operation ways. Results There were 36 cases in laparoscopic group and 33 cases in the open group. The base line in two groups was similar before operation （ P〈0.05）. The length of insection, intraoperative blood loss, recovery time of food intake, length of hospital stay were statistical significance （ P 〈0. 05）, which indicated the laparoscopic group was more advantages. The operating time in two groups has no statistically significant. The overall incidence of complications were different between two groups, with 25.00 % in the laparoscopic group and 48. 48 % in open group. On the other hand, there was no statistical significance in direct operation complications, with 8.33% and 12.12% in each group, respectively. Meanwhile, the incidence of infection were 13.89% in the laparoscopic group and 36.36% in the open group, which was statistically significance. The mortality pert-operation was 2.78% and 6.06% between the laparoscopic group and the open group, and there＇s no statistical significance. The negative edge and length of terminal edge had no statistical different （ P 〉0.05）. The number of lymph node dissection had statistical significance （ P 〈0.05）. The 1-year and 3-year survival rate in two groups were not statistically different（χ2 = 0. 233, 0. 051 ; P = 0. 629, 0. 821 ）. Conclusion The laparoscopic treatment of rectal cancer of stage T4 in patients old than 75 is safe and feasible.