“快通道”外科理念指导下腹腔镜手术治疗老年结直肠癌的临床研究

目的:比较"快通道"外科指导下腹腔镜手术与单纯应用腹腔镜手术及应用"快通道"外科理念的常规开腹手术治疗65岁以上老年结直肠癌患者的有效性、安全性,评估"快通道"外科理念联合腹腔镜手术促进老年结直肠癌患者术后恢复的协同作用。方法:将94例65岁以上老年结直肠癌患者随机分为开腹(open surgery,OP)组、开腹+快通道(open surgery plus fast-track surgery,OPFT)组、腹腔镜(laparoscopy surgery,LAP)组及腹腔镜+快通道(laparoscopy surgery plus fast-track surgery,LAPFT)组。比较患者基线特征、手术效果、术后安全性指标。结果:LAP组与LAPFT组在术中出血量、术后排气时间、术后排便时间、术后阿片类镇痛药物使用时间方面均优于OP组、OPFT组(P0.05),而手术时间明显延长(P0.01)。OPFT组术后首次排便时间、术后阿片类镇痛药物使用时间、住院时间短于OP组(P0.05)。LAP组、LAPFT组术后切口感染率明显低于OP组、OPFT组(P0.01),其他并发症发生率及术后30 d内死亡率各组相比差异无统计学意义(P0.05)。结论:对于老年结直肠癌患者,腹腔镜术中应用"快通道"外科指导的围手术期处理可加快术后康复且不增加术后短期并发症发生率,是安全、有效的治疗措施。

Clinical study of laparoscopic surgery guided by"fast-track"surgery in the treatment of elderly patients with colorectal canc-er

Objective:To compare the efficacy and safety of laparoscopic surgery guided by fast-track surgery,simple laparo-scopic surgery and open surgery guided by fast-track surgery in the treatment of patients over the age of 65 with colorectal cancer,and assess the synergistic effects of fast-track surgery and laparoscopic surgery in promoting the restoration of elderly patients with colorectal cancers. Methods:A total of 94 patients were randomly divided into 4 groups:the open surgery group (OP group,n=18),the open sur-gery plus fast-track surgery group (OPFT group,n=21),the laparoscopy surgery group (LAP group,n=26) and the laparoscopy sur-gery plus fast-track surgery group (LAPFT group,n=29). Parameters for baseline characteristics of patients,operation effect and post-operative safety were compared. Results:LAP group and LAPFT group were better than OP group and OPFT group in intraoperative bleeding,time of first flatus,time of first defecation and time of using postoperative opioid analgesics (P<0. 05),but longer in operative time (P<0. 01). In open surgery the use of perioperative fast-track improvement measures could shorten the time of first defecation, time of using postoperative opioid analgesics and postoperative hospital stay in elderly patients (P<0. 05). In the elderly patients with colorectal cancer undergoing laparoscopic surgery,the perioperative fast-track surgery improvement measures could significantly reduce the postoperative stay (P<0. 01). Incidences of incision infection in LAP group and LAPFT group were significantly lower than those in OP group and OPFT group (P<0. 01). No significant differences were found in mortality within 30 d after surgery and the incidence of other complications among the four groups (P>0. 05). Conclusions:Both of laparoscopic surgery and fast-track surgery can promote postoperative rehabilitation and play synergistic roles in treatment of elderly patients with colorectal cancer. Laparoscopic surgery with perioperative management guided by fast-track surgery,which can accelerate the recovery of patients after operation without increasing the incidence of postoperative complications in short-term outcome,is a kind of safe and effective treatment.