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超高龄患者结直肠癌腹腔镜手术的短期疗效

Short-term outcomes of laparoscopic surgery for colorectal cancer in oldest-old patients.

作者信息

Tominaga Tetsuro, Takeshita Hiroaki, Arai Junichi, Takagi Katsunori, Kunizaki Masaki, To Kazuo, Abo Takafumi, Hidaka Shigekazu, Nanashima Atsushi, Nagayasu Takeshi, Sawai Terumitsu

机构信息

Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan.

出版信息

Dig Surg. 2015;32(1):32-8. doi: 10.1159/000373897. Epub 2015 Feb 10.

Abstract

BACKGROUND/AIMS: Oldest-old patients generally have several comorbidities, and laparoscopic-assisted colectomy (LAC) has not been performed on these patients. However, the surgical technique of LAC has improved, and its indications have been extended. The aim of this study was to evaluate the safety and effectiveness of LAC for patients over 85 years old.

METHODS

Fifty-eight patients over 85 years old who underwent colectomy were retrospectively analyzed. The patients were divided into two groups (LAC group n = 15; open surgery group (Open group) n = 43), and clinicopathological features, surgical characteristics, and outcomes were compared.

RESULTS

There were no significant differences in clinical background characteristics between the groups. The LAC group had longer operation time and greater lymph node dissection (both p < 0.01). Postoperatively, the use of analgesics (p = 0.01) was less and the start of oral liquid intake (p = 0.03) was faster in the LAC group. Postoperative complications occurred in 3 patients (20%) in the LAC group and 13 patients (30%) in the Open group (p = 0.66); delirium (n = 6) and sub-ileus (n = 4) developed only in the Open group.

CONCLUSION

After LAC, elderly patients tended to have less postoperative pain and started oral liquid intake earlier. LAC can be safe and effective, preventing postoperative complications that occur specifically in oldest-old patients.

摘要

背景/目的:高龄患者通常患有多种合并症,且尚未对这些患者实施过腹腔镜辅助结肠切除术(LAC)。然而,LAC的手术技术已有所改进,其适应证也有所扩大。本研究的目的是评估LAC对85岁以上患者的安全性和有效性。

方法

对58例接受结肠切除术的85岁以上患者进行回顾性分析。将患者分为两组(LAC组n = 15;开放手术组(开放组)n = 43),比较临床病理特征、手术特点和结局。

结果

两组之间的临床背景特征无显著差异。LAC组的手术时间更长,淋巴结清扫范围更大(均p < 0.01)。术后,LAC组的镇痛药物使用量更少(p = 0.01),开始口服液体的时间更早(p = 0.03)。LAC组有3例患者(20%)发生术后并发症,开放组有13例患者(30%)发生术后并发症(p = 0.66);谵妄(n = 6)和亚肠梗阻(n = 4)仅在开放组出现。

结论

LAC术后,老年患者术后疼痛往往较轻,开始口服液体的时间更早。LAC可以是安全有效的,可预防高龄患者特有的术后并发症。

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