Scheidbach H, Schneider C, Hügel O, Yildirim C, Lippert H, Köckerling F
Department of Surgery and Center for Minimally Invasive Surgery, Hanover Hospital, Roesebeckstrasse 15 (Siloah), 30499 Hannover, Germany.
Langenbecks Arch Surg. 2005 Aug;390(4):328-32. doi: 10.1007/s00423-005-0560-9. Epub 2005 Jun 3.
In view of the increasing numbers of old and very old people in the general population, we evaluated the short-term outcomes of laparoscopic colorectal surgery for differences between younger and older patients.
A total of 4,823 patients with complete data sets from a prospective, clinical observational multicentre study initiated by the "Laparoscopic Colorectal Surgery Study Group" were analysed for this investigation.
Of the patients, 909 (18.8%) were older and 3,914 (81.2%) younger than 75 years. In the older patient group, malignant disease was a significantly more common indication for surgery. As was expected, the rate of general complications (pneumonia, cardiopulmonary problems, urinary tract infection) was significantly higher in the older patient group with its greater prevalence of preoperative comorbidity, but there no differences in terms of intraoperative or postoperative surgical complications or conversion rate between the groups.
The higher rate of postoperative complications resulting from preoperative comorbidity in the older patients makes it necessary that the indication for surgery be established with care. In view of the advantages of the laparoscopic approach with regard to the postoperative course, the preferential use of laparoscopy for the treatment of colorectal problems requiring surgery in older patients should receive serious consideration.
鉴于普通人群中老年人和高龄老人数量不断增加，我们评估了腹腔镜结直肠手术在年轻患者和老年患者之间的短期结局差异。
本研究分析了“腹腔镜结直肠手术研究组”发起的一项前瞻性临床观察多中心研究中共有4823例具有完整数据集的患者。
在这些患者中，909例（18.8%）年龄≥75岁，3914例（81.2%）年龄＜75岁。在老年患者组中，恶性疾病是手术的明显更常见指征。正如预期的那样，老年患者组中全身并发症（肺炎、心肺问题、尿路感染）的发生率明显更高，因为其术前合并症的患病率更高，但两组之间在术中或术后手术并发症或中转率方面没有差异。
老年患者术前合并症导致术后并发症发生率较高，因此有必要谨慎确定手术指征。鉴于腹腔镜手术在术后过程方面的优势，应认真考虑优先使用腹腔镜治疗老年患者中需要手术的结直肠问题。
