Luigi Sacco University Hospital, Department of Surgery, Milan, Italy.
Academisch Medisch Centrum, Department of Colorectal Surgery, Amsterdam, The Netherlands.
J Crohns Colitis. 2017 Jun 1;11(6):671-679. doi: 10.1093/ecco-jcc/jjw209.
Restorative proctocolectomy in elderly inflammatory bowel disease [ IBD] patients is controversial and limited data are available on the outcomes of surgery. The aim of this study was to evaluate the safety, efficacy, and long-term results of ileal-pouch-anal anastomosis in elderly patients, in a multicentre survey from European referral centres.
The International Pouch Database [IPD] combined 101 variables. Patients aged ≥ 65 years were matched on the basis of open versus laparoscopic surgery with a control group of consecutive younger unselected patients with a ratio of 1:2. Statistical analysis was performed using two-tailed t test, chi square and Fisher's exact tests, Kaplan-Meier function, and log-rank tests where appropriate.
In the IPD, 77 patients aged ≥ 65 years [Group A] and 154 control patients [Group B] were identified. Elderly patients had more comorbidities [p = 0.0001], longer disease duration [p = 0.001], less extensive disease [p = 0.006], more previous abdominal operations [p = 0.0006], surgery for cancer or dysplasia more frequently [p = 0.0001], fewer single-stage procedures [p = 0.03], more diversions after ileal pouch-anal anastomosis [IPAA] [p = 0.05], and a higher laparoscopic conversion rate [p = 0.04]. Postoperative complications and pouch failure were similar between the groups, but Group A had more Clavien-Dindo IV-V complications [p = 0.04], and longer length of stay [p = 0.007]. Laparoscopy was associated with a shorter duration of surgery [p = 0.0001], and length of stay [p = 0.0001], and the same complication rate as open surgery.
Restorative proctocolectomy can be performed in selected elderly patients, but there is a higher risk of postoperative complications and longer length of stay in this group. Laparoscopy is associated with shorter operating time and length of stay.
在老年炎症性肠病（IBD）患者中进行修复性直肠结肠切除术存在争议，目前关于手术结果的数据有限。本研究的目的是评估来自欧洲转诊中心的多中心调查中，回肠袋肛管吻合术在老年患者中的安全性、疗效和长期结果。
国际袋数据库（IPD）结合了 101 个变量。根据开放性与腹腔镜手术对年龄≥65 岁的患者进行匹配，并与连续选择的年轻未选择患者进行 1:2 配对，统计分析采用双侧 t 检验、卡方检验和 Fisher 精确检验、Kaplan-Meier 函数和对数秩检验。
在 IPD 中，确定了 77 名年龄≥65 岁的患者（A 组）和 154 名对照患者（B 组）。老年患者合并症更多（p = 0.0001），疾病持续时间更长（p = 0.001），病变范围较小（p = 0.006），既往腹部手术更多（p = 0.0006），手术治疗癌症或异型增生更频繁（p = 0.0001），一期手术较少（p = 0.03），回肠袋肛管吻合术后转流更多（p = 0.05），腹腔镜转化率更高（p = 0.04）。两组术后并发症和袋失败相似，但 A 组更常见 Clavien-Dindo IV-V 级并发症（p = 0.04），住院时间更长（p = 0.007）。腹腔镜手术与手术时间和住院时间更短相关（p = 0.0001），与开放性手术的并发症发生率相同。
修复性直肠结肠切除术可在选择的老年患者中进行，但该组术后并发症风险较高，住院时间较长。腹腔镜手术与较短的手术时间和住院时间相关。
