CAJ | 학술논문

目的探讨腹腔镜手术治疗合并常见慢性病的老年直肠癌患者的可行性、安全性及疗效.方法回顾性总结2003年1月至2008年12月南方医科大学南方医院收治的192例合并常见慢性病的老年直肠癌患者的临床资料.192例患者分为腹腔镜组(91例)和开腹组(101例),比较两组患者的手术学指标、肿瘤学指标、预后指标.计量、计数资料分别采用t检验和x2检验,患者生存情况采用寿命表法和Kaplan-Meier法.结果腹腔镜组和开腹组患者保肛率、手术时间、术后住院时间、术后主要并发症发生率分别为85.7%(78/91)、(194±61)min、(14±8)d、24.2%(22/91)和85.1%(86/101)、(187±58)min、(14±8)d、28.7%(29/101),其差异无统计学意义(x2=0.012,t=0.874,-0.265,x2=0.505,P＞0.05);术中出血量、术后肛门排气时间、进流质饮食时间和下床活动时间分别为(108±78)ml、(3±1)d、(4±2)d、(3±1)d和(270±600)ml、(4±1)d、(5±2)d、(5±1)d,其差异有统计学意义(t=-2.650,-4.545,-4.587,-13.310,P＜0.05).腹腔镜组和开腹组患者标本切除长度、淋巴结清扫数目分别为(18±5)cm、(9±7)枚和(18±5)cm、(9±8)枚,其差异无统计学意义(t=1.457,0.021,P＞0.05);而腹腔镜组肠管远切缘长度(3.8±1.5)cm显著长于开腹组的(3.1±1.5)cm(t=0.283,P＜0.05).腹腔镜组和开腹组患者3年累积生存率、总复发率、局部复发率、远处转移率分别为76%、12.1%(11/91)、2.2%(2/91)、9.9%(9/91)和82%、14.9%(15/101)、6.9%(7/101)、7.9%(8/101),其差异无统计学意义(U=2.600,x2=0.312,2.400,0.230,P＞0.05);生存分析显示,两组TNM Ⅰ、Ⅱ、Ⅲ期和Ⅰ～Ⅲ期患者累积生存率比较,差异无统计学意义(P＞0.05).结论腹腔镜手术治疗合并常见慢性病的老年直肠癌患者是安全可行的,在术后恢复方面显示出明显的微创价值.
목적 탐토복강경수술치료합병상견만성병적노년직장암환자적가행성、안전성급료효.방법 회고성총결2003년1월지2008년12월남방의과대학남방의원수치적192례합병상견만성병적노년직장암환자적림상자료.192례환자분위복강경조(91례)화개복조(101례),비교량조환자적수술학지표、종류학지표、예후지표.계량、계수자료분별채용t검험화x2검험,환자생존정황채용수명표법화Kaplan-Meier법.결과 복강경조화개복조환자보항솔、수술시간、술후주원시간、술후주요병발증발생솔분별위85.7%(78/91)、(194±61)min、(14±8)d、24.2%(22/91)화85.1%(86/101)、(187±58)min、(14±8)d、28.7%(29/101),기차이무통계학의의(x2=0.012,t=0.874,-0.265,x2=0.505,P＞0.05);술중출혈량、술후항문배기시간、진류질음식시간화하상활동시간분별위(108±78)ml、(3±1)d、(4±2)d、(3±1)d화(270±600)ml、(4±1)d、(5±2)d、(5±1)d,기차이유통계학의의(t=-2.650,-4.545,-4.587,-13.310,P＜0.05).복강경조화개복조환자표본절제장도、림파결청소수목분별위(18±5)cm、(9±7)매화(18±5)cm、(9±8)매,기차이무통계학의의(t=1.457,0.021,P＞0.05);이복강경조장관원절연장도(3.8±1.5)cm현저장우개복조적(3.1±1.5)cm(t=0.283,P＜0.05).복강경조화개복조환자3년루적생존솔、총복발솔、국부복발솔、원처전이솔분별위76%、12.1%(11/91)、2.2%(2/91)、9.9%(9/91)화82%、14.9%(15/101)、6.9%(7/101)、7.9%(8/101),기차이무통계학의의(U=2.600,x2=0.312,2.400,0.230,P＞0.05);생존분석현시,량조TNM Ⅰ、Ⅱ、Ⅲ기화Ⅰ～Ⅲ기환자루적생존솔비교,차이무통계학의의(P＞0.05).결론 복강경수술치료합병상견만성병적노년직장암환자시안전가행적,재술후회복방면현시출명현적미창개치.
Objective To evaluate the feasibility, safety and clinical outcome of laparoscopic radical resection of rectal cancer in elderly patients with common chronic comorbidities. Methods The clinical data of 192 elderly patients with rectal cancer and common chronic comorbidities who were admitted to the Nanfang Hospital from January 2003 to December 2008 were retrospectively analyzed. All patients were divided into laparoscope group (n=91) and open group (n = 101). The operative procedures, clinicopathological data and outcomes of the two groups were collected and compared. All data were analyzed using the t test and chi-square test, and the survival of patients was analyzed using the life table and Kaplan-Meier curves. Results The sphincter preservation rate,operation time, postoperative length of hospital stay, morbidity rate were 85.7% (78/91), (194 ± 61) minutes,(14 ±8)days, 24.2% (22/91) in the laparoscope group, and they were 85.1% (86/101), (187 ±58) minutes,(14 ±8)days and 28.7% (29/101) in the open group, with no significant difference between the two groups (x2=0.012, t=0.874,-0.265, x2 =0. 505 , P ＞ 0. 05) . The intraoperative blood loss was (108 ±78)ml in the laparoscope group, which was significantly less than (270 ± 600) ml in the open group (t =-2. 650, P ＜0.05). The time to first flatus, time to liquid diet, time to out-of-bed activity were (3 ± 1) days, (4 ± 2) days and (3 ± 1)days, which were significantly shorter than (4 ± 1)days, (5 ± 2)days and (5 ± 1)days in the open group,respectively (t =-4. 545,-4. 587,-13. 310, P ＜ 0.05). The length of rectum resected and the number of lymph node dissected were (18 ± 5)cm and 9 ± 7 in the laparoscope group, and (18 ± 5)cm and 9 ± 8 in the open group, respectively, with no significant difference between the two groups (t = 1. 457, 0. 021, P ＞ 0.05), while the distance of distal resection margin to the tumors was (3.8 ± 1.5) cm, which was significantly longer than (3.1 ± 1.5) cm of the open group (t = 0. 283, P ＜ 0. 05). The 3-year cumulative survival rate, overall recurrence rate, local recurrence rate and distal metastasis rate in the laparoscope group were 76%, 12. 1% (11/91), 2.2% (2/91) and 9.9% (9/91), and they were 82%, 14.9% (15/101), 6.9% (7/101), 7.9% (8/101) in the open group, respectively, with no significant difference between the two groups (U=2. 600, x2 =0. 312, 2.400,0. 230, P ＞ 0.05). There were no significant difference in the cumulative survival rate between patients in TNM stage Ⅰ, Ⅱ and Ⅲ in the two groups (P ＞ 0.05). Conclusion Laparoscopic radical resection of rectal cancer is safe and feasible for elderly patients with common chronic comorbidities, and it has the advantages in quick recovery of patients after operaion.