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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2018, Vol. 12 ›› Issue (05) : 324 -327. doi: 10.3877/cma.j.issn.1674-0793.2018.05.009

所属专题： 文献；

论著

加速康复外科在老年结直肠癌患者中的应用
曹明晓1, 姜立新2,†(), 胡金晨2, 王东2, 张振彬2, 张孟来2   
  1. 1. 264000　青岛大学附属烟台毓璜顶医院胃肠外二科
    2. 264000　青岛大学附属烟台毓璜顶医院胃肠外一、甲状腺外科
  • 收稿日期:2018-01-17 出版日期:2018-10-01
  • 通信作者: 姜立新

Application of enhanced recovery after surgery in aged patients undergoing radical colorectal surgery

Mingxiao Cao1, Lixin Jiang2,†(), Jinchen Hu2, Dong Wang2, Zhenbin Zhang2, Menglai Zhang2   

  1. 1. The Second Department of Gastroenterological Surgery, Affiliated Hospital of Qingdao University-Yantai Yuhuangding Hospital, Yantai 264000, China
    2. Department of Parenteral and Thyroid Surgery, Affiliated Hospital of Qingdao University-Yantai Yuhuangding Hospital, Yantai 264000, China
  • Received:2018-01-17 Published:2018-10-01
  • Corresponding author: Lixin Jiang
  • About author:
    Corresponding author: Jiang Lixin, Email:
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引用本文：

曹明晓, 姜立新, 胡金晨, 王东, 张振彬, 张孟来. 加速康复外科在老年结直肠癌患者中的应用[J]. 中华普通外科学文献(电子版), 2018, 12(05): 324-327.

Mingxiao Cao, Lixin Jiang, Jinchen Hu, Dong Wang, Zhenbin Zhang, Menglai Zhang. Application of enhanced recovery after surgery in aged patients undergoing radical colorectal surgery[J]. Chinese Archives of General Surgery(Electronic Edition), 2018, 12(05): 324-327.

目的

探讨围手术期中将加速康复外科（ERAS）理念应用于老年结直肠癌患者的安全性和有效性。

方法

收集2015年2月至2017年1月烟台毓璜顶医院应用ERAS理念的结直肠癌手术患者的临床资料，共纳入160例患者，根据年龄分为青年组（<65岁，97例）和老年组（≥65岁，63例），对比研究两组患者的胃肠功能恢复情况、术后并发症、术后住院时间。

结果

相对于青年组，老年组患者ASA评分更高（χ2=10.960，P=0.001），并且明显合并更多的基础病（P<0.05）。两组患者手术类型、手术方式以及术后并发症总发生率、严重并发症发生率差异无统计学意义（χ2=0.171、1.039、0.296、0.001，P=0.680、0.595、0.586、0.979）。老年组患者非手术并发症尤其是心血管并发症更常见。青年组患者二次手术率为6.2%，再入院率为5.2%；老年组分别为9.5%、3.2%，两组差异无统计学意义（χ2=0.641、0.041，P=0.433、0.839）。老年组患者肠功能恢复较慢，术后首次肛门排气、术后首次肛门排便、住院时间较青年组患者明显延长（Z=1.89、2.37、3.11，P=0.034、0.013、0.001）。

结论

加速康复外科在老年患者结直肠癌手术中的应用是安全有效的。

关键词: 结直肠肿瘤, 加速康复外科, 结直肠外科手术, 并发症, 老年人
Objective

To evaluate the safety and efficacy of enhanced recovery after surgery (ERAS)combined with radical colorectal surgery for aged patients with colon cancer or rectal cancer.

Methods

From February 2015 to January 2017, the clinical data of one hundred and sixty patients undergoing radical colorectal cancer surgery combined with ERAS in Yantai Yuhuangding Hospital were collected. They were divided into two groups: the young group (< 65 years old, 97 cases) and the elderly group (≥65 years old, 63 cases). The recovery of gastrointestinal function, postoperative complications and the length of hospital stay between the two groups were compared.

Results

Compared with the young group, ASA score and the ratio of basic diseases of the elderly patients were higher (χ2=10.960, P=0.001). There was no significant difference in the type of operation, the mode of operation, the rate of postoperative complications and the incidence of serious complications between the two groups (χ2=0.171, 1.039, 0.296, 0.001, P=0.680, 0.595, 0.586, 0.979) . Non-operative complications, especially cardiovascular complications, were more common in the elderly patients. The incidence of reoperation and readmission were 6.2%, 5.2% in the young group, and 9.5%, 3.2% in the elderly group respectively, with no statistical differences (χ2=0.641, 0.041, P=0.433, 0.839) . In the elderly group, intestinal function recovery was slower, postoperative anal exhaust, postoperative anal defecation and hospitalization time were significantly longer than those in the young group (Z=1.89, 2.37, 3.11, P=0.034, 0.013, 0.001).

Conclusion

The combination of ERAS and radical colorectal surgery is safe and effective in aged patients with colon cancer or rectal cancer.

Key words: Colorectal neoplasms, Enhanced recovery after surgery, Colorectal Surgery, Complication, Aged
表1 160例结直肠癌患者的基本资料
组别 例数 男/女(例) 中位年龄[岁,M(Q)] 体质量指数（kg/m2） ASA评分[例(%)] WHO评分[例(%)] 合并疾病[例(%)]
1~2 3~4 1~2 3~4 糖尿病 心脏病 呼吸系统
青年组 97 57/40 52(44~62) 24.8±1.2 80(82.5) 17(17.5) 90(92.8) 7(7.2) 7(7.2) 9(9.3) 10(10.3)
老年组 63 34/29 73(67~80) 25.2±0.9 37(58.7) 26(41.3) 54(85.1) 9(14.9) 13(20.6) 16(25.4) 14(22.2)
统计值 ? 0.358a -b 0.573c 10.960 a 2.121 a 6.287 a 7.527 a 4.251 a
P值 ? 0.550 <0.001 0.878 0.001 0.145 0.012 0.006 0.039
表2 160例结直肠癌患者的根治手术资料比较［例(%)，χ2检验］
组别 例数 手术类型 手术方式
结肠癌 直肠癌 腹腔镜 开腹 中转开腹
青年组 97 37(38.1) 60(51.9) 78(80.4) 9(9.3) 10(10.3)
老年组 63 22(34.9) 41(65.1) 47(74.6) 9(14.3) 7(11.1)
χ2值 ? 0.171 1.039
P值 ? 0.680 0.595
表3 160例结直肠癌患者术后并发症情况[例(%)，χ2检验]
项目 青年组(97例) 老年组(63例) χ2值 P值
住院期间总并发症 45(46.4) 32(50.8) 0.296 0.586
严重并发症(Clavien Ⅲ~Ⅳ) 14(14.4) 9(14.3) 0.001 0.979
手术并发症 15(15.5) 11(17.5) 0.112 0.738
吻合口瘘 4(4.1) 3(4.8) 0.000 1.000
手术部位感染 5(5.2) 5(7.9) 0.504 0.478
心血管系统并发症 3(3.1) 6(9.5) 2.976 0.085
呼吸系统并发症 7(7.2) 7(11.1) 0.726 0.394
非手术部位感染并发症 15(15.5) 13(20.6) 0.707 0.400
尿潴留 8(8.2) 10(15.9) 2.224 0.136
出院后并发症 11(11.3) 7(11.1) 0.002 0.964
二次手术 6(6.2) 6(9.5) 0.614 0.433
再入院 5(5.2) 2(3.2) 0.041 0.839
死亡 0(0) 1(1.6) - 0.394
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