腹腔镜与传统开腹手术治疗老年直肠癌患者的临床疗效对比

目的:对比分析老年患者行腹腔镜直肠癌根治术与传统开腹手术的近远期临床疗效。方法:回顾分析2007年1月至2013年9月为100例老年患者行直肠癌根治术的临床资料,其中50例行腹腔镜手术(腹腔镜组),50例行开腹手术(开腹组)。对比两组患者术中、术后情况,并进行生存分析。结果:两组患者手术时间、清扫淋巴结数量、肿瘤大小、切缘距离及术后肺感染、肠梗阻、肠漏发生率差异无统计学意义(P>0.05);术中失血量、切口长度、排气时间、下床活动时间、术后引流时间、VAS评分、术后住院时间、住院费用、切口感染差异有统计学意义(P<0.05)。两组患者5年总生存率分别50.6%与56.0%,差异无统计学意义(P>0.05)。结论:腹腔镜手术治疗老年直肠癌患者并不增加手术时间,且短期疗效与生活质量得到了改善,同样可达到开腹手术的根治程度,不影响预后,术前把握手术适应证,腹腔镜直肠癌根治术是安全、有效的,且术中失血量少,术后康复快,值得推广。

Clinical comparison of laparoscopic and conventional open surgery in elder patients with rectal cancer

Objective： To compare and analyze the short-and long-term clinical efficacy between laparoscopic and conventional open surgery in elder patients with rectal cancer. Methods： A retrospective analysis was made on the clinical data of 100 elder patients who received radical resection of rectal cancer from Jan. 2007 to Sep. 2013. The patients were divided into laparoscopic group（ n = 50）and open group（ n = 50）. Operation related index,postoperative recovery and survival rate of 2 groups were compared and analyzed. Results： There was no statistically significant difference in operation time,number of lymphadenectomy,tumor size,resection margin,lung infection,intestinal obstruction and intestinal leakage（ P〉0. 05）,but the blood loss,length of incision,postoperative exhaust time,time of ambulation,the postoperative drainage time,VAS score,hospital stay,cost and incision infection had statistically significant difference（ P〈0. 05）. The 5-year overall survival rates were 50. 6% in the open group and 56. 0% in the laparoscopic group,there was no differences between the two groups（ P〉0. 05）. Conclusions： Laparoscopic operation does not increase operative time or affect prognosis in the treatment of elder patients with rectal cancer,improves the short-term therapeutic effect and life quality,can be as radical as laparotomy. If the operative indications are grasped before operation,laparoscopic operation is safe,effective with less intraoperative blood loss and faster recovery. It is worth wide application in elder patients with rectal cancer.