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Laparoscopic Colectomy for Nonagenarians, Preliminary Experience in National Taiwan University Hospital

九十歲以上病人的腹腔鏡大腸切除手術-台大醫院之初始經驗

摘要


目的 近十年來,腹腔鏡大腸切除手術已經廣泛應用於大腸直腸腫瘤之治療。然而,對於九十歲以上的老年人,腹腔鏡手術的資料仍然相當缺乏。本研究主要是探討單一醫院腹腔鏡大腸切除手術用於九十歲以上病人的經驗。 方法 從2001年1月到2009年7月,我們進行了回溯病例控制研究,收集所有因為原發大腸直腸腫瘤而在本院接受腹腔鏡或剖腹大腸切除手術的病人資料,有35個病人在接受手術時超過90歲,他們的身體狀況,腫瘤狀況,手術方法,實驗室檢查,致病及致死率,以及存活皆加以分析。 結果 腹腔鏡大腸切除以及剖腹大腸切除兩組分別各收集了十一個病人。平均年齡為92.3歲對93.3歲;最常見的術式分別為腹腔鏡前方切除手術(45%)及右側結腸切除手術(27.3%)。平均手術時間為224.5分鐘而平均失血量則為172.2毫升。平均住院天數為16.9天。有三個病人產生輕微併發症(27.3%),一個病人因為嚴重併發症而死亡(9.1%)。平均追蹤時間是19個月而五年存活率則是54.6%,腹腔鏡組和剖腹組相比沒有統計上的差異。 結論 腹腔鏡組的短期及長期成績和剖腹組相比起來並沒有差別。本研究的手術後致病率及致死率和其他研究的七十歲或八十歲以上病人比較,並沒有顯著差異。因此,慎選九十歲以上患有大腸直腸腫瘤的病人,腹腔鏡大腸切除手術是個安全而有效的治療方式。

並列摘要


Purpose. Over the past decade, laparoscopic colectomy has been widely used for patients with colorectal neoplasm. However, there is little data about laparoscopic surgery among nonagenarians. This study discusses our clinical experience of laparoscopic colectomy for nonagenarians in a single institute. Methods. From January 2000 to July 2009, we performed a retrospective case control study of patients who underwent laparoscopic or open colectomy due to a primary colon tumor. Thirty-five patients were older than 90 years old. The demographics, tumor characteristics, surgical methods, lab data, morbidity, mortality, and survival were investigated and analyzed. Results. Eleven patients underwent laparoscopic colectomy and eleven underwent open colectomy were enrolled. The mean age entering surgery was 92.3 versus 93.3. The most common operation procedure was a laparoscopic anterior resection (45%) versus open right hemicolectomy (27.3%). The average of hospital stay was 16.9 (8-39) days versus 23.9 (10-69) days. Four patients in laparoscopic group (36.4%) and five in open group (45.5%) suffered complications. There was one 30 days-mortality (9.1%) in laparoscopic group. The median follow-up interval was 19 versus 13 months and the five year survival rate was 54.6% versus 33.8%. Conclusion. The short-tern and long-tern result of laparoscopic group are not worse than open group. The mortality and morbidity rates in our study are not higher than octogenarians or septuagenarians of other studies. For nonagenarians with colorectal neoplasm, laparoscopic colectomy is a feasible and safe option for selective patients.

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