Laparoscopic Colorectal Surgery for the Aged People

腹腔鏡大腸直腸手術於老年人的應用

鄭智元(Che-Yuan Cheng) ； 王輝明(Hwei-Ming Wang) ； 陳周斌(Joe-Bin Chen)

《中華民國大腸直腸外科醫學會雜誌》 16卷3期 (2005/09) Pp. 67-72

https://doi.org/10.6312/SCRSTW.2005.16(3).09409

摘要

目的　傳統開腹式手術常因傷口疼痛而影響術後心肺功能，尤其對於常伴隨心肺功能障礙的年老病患具有相當危險性，甚至需在加護病房術後照顧。至於腹腔鏡手術雖然可減輕病人的疼痛，有術後恢復較快的正面好處，但是腹腔鏡手術長時間高壓氣腹也會對心肺功能有負面影響。因此，我們收集在單一醫院中接受腹腔鏡大腸直腸手術的老年病例，對其手術結果加以分析，以評估此類手術對於年老病患而言，是否與傳統開腹式手術一樣安全。
材料及方法　我們收集自西元1998年9月起至2002年10月為止，在台中榮民總醫院接受常規性腹腔鏡或剖腹式大腸直腸手術、而且年齡超過75歲以上的病人資料。資料分析重點在手術的併發症與死亡率。
結果　共有79位病人接受腹腔鏡手術，平均年齡為78.7±3.7歲，55位男性與24位女性。其中76位為惡性疾病，手術併發症機率為27.8%。有2位(2.5%)手術併發症需要進一步手術治療，手術死亡率為3.8%。至於傳統手術組，共有82位病人，平均年齡為79.3±4.2歲，58位男性與24位女性。其中81位為惡性疾病。手術併發症機率為35.4%，手術死亡率為6.1%。
結論　根據本研究的結果，腹腔鏡大腸直腸手術可安全施行於年老病患。

關鍵字

腹腔鏡手術 ； 大腸直腸疾病 ； 老年人

並列摘要

Purpose. Controversial issues surrounding laparoscopic colorectal surgery include longer time required to complete the difficult surgery and the high conversion and complication rates as previously reported. Most important, the laparoscopic procedures may adversely affect aged people, who often have compromised cardiopulmonary function. The purpose of this single-center, retrospective study was to evaluate the feasibility of laparoscopic colorectal surgery in the aged patients with colorectal disease.
Methods. We collect the data of patients with the age of 75 years or more, who had elective laparoscopic or open colorectal surgery, from September, 1998 to October, 2002.
Results. There were 79 patients in the laparoscopic surgery group (LAC group) and 82 patients in the conventional open surgery group (OC group). The mean age of the LAC group was78.7±3.7 years and that of the OC group was79.3±4.2 years. There were 55 male and 24 female patients in the LAC group and 58 male and 24 female in the OC group. Seventy six patients in the LAC group and 81 patients in the OC group had colorectal or anal cancer. The conversion rate of the LAC group was 1.3% (1/79). The operative complication rate was 27.8% for the LAC group and 35.4% for the OC group. Complications requiring further open operations in the LAC group occurred in two patients (2.5%). The mortality rate was 3.8% in the LAC group and 6.1% in the OC group.
Conclusion. According to the results of the study, we consider that laparoscopic surgery for colorectal diseases is as safe as the open method for the aged patients.

並列關鍵字

Laparoscopic surgery ； Colorectal disease ； Elderly people