Law Wai Lun, Chu Kin Wah, Tung Peter Hiu Ming
Department of Surgery, Queen Mary Hospital, University of Hong Kong Medical Centre, Hong Kong, China.
J Am Coll Surg. 2002 Dec;195(6):768-73. doi: 10.1016/s1072-7515(02)01483-7.
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.
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.
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.
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.
老年患者的开放性结直肠手术与较高的发病率和死亡率相关。腹腔镜结直肠切除术良好的短期疗效可能会降低老年患者的发病率。本研究比较了接受腹腔镜结直肠切除术的老年患者（70岁及以上）与接受开放性手术的患者的结果。
纳入2000年6月至2001年12月期间接受择期结直肠切除术的70岁及以上连续患者。前瞻性收集有关人口统计学、疾病、手术细节和术后事件的数据。对腹腔镜手术和开放性手术的结果进行比较。
在研究期间，65例患者接受了腹腔镜结肠切除术，89例接受了开放性手术。开放性手术组和腹腔镜手术组的中位年龄分别为77岁和75岁。两组患者的病前合并症情况、美国麻醉医师协会评分和既往手术发生率相似。腹腔镜手术组的中位手术时间较长（180分钟对135分钟，p<0.001），但失血量较少（100 mL对200 mL，p=0.001）。8例患者转为开放性手术。腹腔镜手术组有1例患者死亡，开放性手术组有5例患者死亡。与开放性结直肠切除术相比，腹腔镜切除术与肠道功能恢复更早（3天对4天，p=0.004）、固体饮食恢复更早（3天对5天，p<0.001）、住院时间更短（7天对9天，p=0.001）以及心肺并发症更少（7.7%对22.4%，p=0.033）相关。
腹腔镜结直肠切除术对老年患者是一种安全的选择，在肠道功能恢复更早、饮食恢复更早和住院时间更短方面具有更有利的短期疗效。它还与较少的心肺并发症相关，这是老年患者结直肠手术后的一种重要并发症。
