【摘要】 目的 分析肛提肌外腹会阴联合切除术(ELAPE)治疗老年低位直肠癌的安全性和短期预后情况。方法 收集2011年9月至2013年2月于北京大学人民医院胃肠外科就诊,术前经活检病理确诊,行ELAPE术式的低位直肠癌患者(距肛缘3~6 cm)36例,其中<60岁(非老年组)18例,≥60岁(老年组)18例。比较2组患者手术安全性指标、术后排尿功能、术后生活质量、经济学指标、总体生存期(OS)及无进展生存期(PFS)差异。结果 老年组术前并发症比例明显高于非老年组[61.1%(11/18)比27.8%(5/18),P<0.05];老年组与非老年组手术时间、术中出血量、排气时间、排便时间、恢复进食时间、会阴引流拔除时间、会阴引流量、会阴伤口拆线时间、术后并发症发生率等手术安全性指标差异均无统计学意义[(289±49)min比(289±44)min,(157±103)ml比(254±179)ml,(3.7±1.2)d比(4.2±1.6)d,(6.1±2.5)d比(6.4±2.4)d,(5.8±1.5)d比(6.1±1.8)d,(11±5)d比(11±4)d,(53±37)ml比(48±30)ml,(11.5±2.4)d比(10.2±2.4)d,27.8%(5/18)比44.4%(8/18);均P>0.05];老年组与非老年组术后最大尿流率、排尿量、残余尿量等排尿功能指标差异无统计学意义[(14±7)ml/s比(17±7)ml/s,(221±96)ml比(259±123)ml,(83±11)ml比(99±16)ml;均P>0.05];老年组与非老年组术后生活质量评分差异均无统计学意义(均P>0.05);老年组和非老年组患者总住院时间、术后住院时间及住院花费差异无统计学意义[(25±10)d比(24±7)d,(19±11)d比(18±7)d,(6.1±2.2)万元比(5.3±1.3)万元;均P>0.05]。老年组和非老年组中位OS分别为13.5(5~26)和12.5(4~24)个月,中位PFS分别为12(3~26)和10(4~24)个月,差异均无统计学意义(均P>0.05)。结论 ELAPE术式用于老年低位直肠癌患者安全可行,短期预后与非老年患者相当。更多还原

【Abstract】 Objective To explore the safety and short-term prognosis of extra-levator abdominoperineal excision in elderly patients with lower rectal cancer.Methods Totally 36 patients with lower rectal cancer confirmed by pathology,including 18 cases ≥60 years old(elder group) and 18 cases < 60 years old(non-elder group) from September 2011 to February 2013 were collected.The surgical safety parameters,postoperative urinary function,quality of life,economic parameters,overall survival(OS) and progression free survival(PFS) were compared between the two groups.Results The proportion of patients with preoperative comorbidities in elder group was significantly higher than that in non-elder group[61.1%(11/18) vs 27.8%(5/18),P<0.05].There were no statistical differences regarding surgical safety parameters including operating time,blood loss,evacuation time,defecation time,first eating time,perineal drainage taken time,drainage of perineum,perineal wound stitches removal time and incidence of post-operative complications between elder group and non-elder group[(289 ±49) min vs(289+44) min,(157 ±103) ml vs(254 + 179) ml,(3.7 ±1.2) d vs(4.2 ±1.6) d,(6.1 ±2.5) dvs(6.4 ±2.4) d,(5.8 ±1.5) dvs(6.1 ±1.8) d,(11 ±5) dvs(11 ±4) d,(53+37) ml vs(48 ±30) ml,(11.5+2.4) dvs(10.2 ±2.4) d,27.8%(5/18) vs 44.4%(8/18)](all P > 0.05];there were no significant differences of postoperative urinary function including the maximum urinary flow-rate,urine output and perineal drainage taken time,between elder group and non-elder group[(14 ± 7) ml/s vs(17 ± 7) ml/s,(221+96) ml vs(259±123) ml,(83 ±107) ml vs(99 ±162) ml](allP>0.05];no differences of life quality were found between the two groups(P > 0.05);there were no statistical difference of economic parameters including total hospitalization stays,postoperative hospital stays and total hospitalization cost between elder group and non-elder group[(25 + 10) dvs(24±7) d,(19 ± 11) d vs(18 ± 7) d,(6.1 ± 2.2) thousands yuan vs(5.3 ±1.3) thousands yuan](all F > 0.05].The OS showed no significant difference between elder group and non-elder group[13.5(5-26) months vs 12.5(4-24) months],so did PFS[12(3-26) months vs 10(4-24)months](all P >0.05).Conclusion The ELAPE procedure is safe for elderly patients with lower rectal cancer,with similar short-term prognosis with that in non elderly ones.更多还原