中国普外基础与临床杂志

中国普外基础与临床杂志

高龄对超低位直肠或肛管癌患者行经内外括约肌间切除术后近期疗效的影响

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目的 探讨高龄对超低位直肠或肛管癌患者行经内外括约肌间切除(ISR)术后的近期疗效是否有影响。 方法 前瞻性纳入 2016 年 2 月至 2017 年 2 月期间符合本研究纳入条件的患者共 196 例,根据患者年龄进行分组,将年龄≥75 岁的患者纳入高龄组,<75 岁的患者纳入非高龄组,比较 2 组患者行 ISR 术后的近期疗效。 结果 高龄组 113 例,非高龄组 83 例,2 组患者在性别构成、体质量指数、肿瘤组织学类型、分化程度、肿瘤大小、距肛缘距离等方面比较差异均无统计学意义(P>0.05),但高龄组的麻醉 ASA 评分明显高于非高龄组(P=0.002),且合并症肺功能不全、低蛋白血症、贫血、高血压、糖尿病、心功能不全比例均明显高于非高龄组(P 值分别为 0.005、0.048、0.009、0.001、0.000、0.042),其他内科合并症如冠心病、胃溃疡、精神疾病、血栓比例等 2 组间比较差异均无统计学意义(P>0.05)。2 组患者的手术时间及术中出血量比较差异均无统计学意义(P>0.05),高龄组患者的首次排气时间、首次进食时间、首次排便时间、下床活动时间及住院时间均较非高龄组长(P 值分别为 0.023、0.037、0.019、0.020 及 0.012)。2 组总并发症发生率比较差异无统计学意义(P>0.05),2 组吻合口瘘、肛周感染、肠梗阻及切口感染发生率比较差异均无统计学意义(P>0.05)。196 例患者均获得随访,随访率为 100%;平均随访 7 个月。随访期间出现复发患者 4 例,其中高龄组 3 例,非高龄组 1 例。随访期间死亡患者 3 例,其中高龄组组 2 例,非高龄组 1 例。 结论 高龄超低位直肠或肛管癌患者由于术前状态较差,行 ISR 术后较非高龄患者的近期恢复更缓慢,但是高龄并没有增加超低位直肠或肛管癌患者行 ISR 术后的并发症发生,因此,对于高龄超低位直肠或肛管癌患者行 ISR 术仍然是安全、有效的,但这需要手术医师需具备较高的手术技术能力并且多学科的良好协作。

Objective To discuss whether age has an influence on short-term effect of intersphincteric resection (ISR) for elderly (≥75 years old) patients with ultra-low rectal or canal cancer or not. Methods From February 2016 to February 2017, 196 patients with ultra-low rectal or canal cancer received ISR in Gastrointestinal Surgery Centers of West China Hospital were eligible to include in this study, then they were divided into ≥75 years old group and <75 years old group according to the patients’ age. The intraoperative index, postoperative index, and occurrence rate of complications were compared between these two groups. Results There were 112 cases in the ≥75 years old group, 83 cases in the <75 years old group, the baselines such as the gender composition, body mass index, tumor histology type, differentiation degree, tumor size, distance from the anal margin had no significant differences ( P>0.05), but the preoperative anaesthetized ASA score, proportions of pulmonary insufficiency, hypoproteinemia, anemia, hypertension, diabetes, and cardiac insufficiency of the ≥75 years old group were significantly higher than those of the <75 years old group. The operation time, intraoperative bleeding volume, and total complications rates had no differences between these two groups (P>0.05), the first exhaust time, the first eating time, the first defecation time, the first ambulation time, and hospitalization time of the ≥75 years old group were significantly longer than those of the <75 years old group (P=0.023, 0.037, 0.019, 0.020, and 0.012, respectively). There were no significant differences in the incidence of the anastomotic leakage, perianal infection, intestinal obstruction, and wound infection between these two groups (P>0.05). All the 196 patients were followed-up with an average follow-up of 7 months, there were 4 cases of recurrent patients, of which 3 were in the ≥75 years old group and 1 in the <75 years old group; there were 3 cases of death, of which 2 were in the ≥75 years old group and 1 was in the <75 years old group. Conclusions The short-term recovery of elderly patients with ultra-low rectal or canal cancer is more slow than younger patients because of poor preoperative conditions. ISR surgery is still safe and effective for elderly patients with ultra-low rectal or canal cancer and postoperative complications rate has no obvious difference, but it needs a surgeon’s skilled operation technology and multi-disciplinary team cooperation.

关键词: 高龄; 超低位直肠或肛管癌; 经内外括约肌间切除; 近期疗效

Key words: elderly; ultra-low rectal/canal cancer; intersphincteric resection; short-term effect

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