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| 不同年龄段老年直肠癌的临床特征及术后并发症的危险因素分析 |
| Analysis of clinicopathological features and risk factors for postoperative complications at different ages in elderly patients with rectal cancer |
| 投稿时间：2017-02-15 |
| DOI：10.3969/j.issn.1000-0399.2017.11.022 |
| 中文关键词: 直肠癌 老年 临床特征 术后并发症 |
| 英文关键词: Rectal cancer Elderly Clinicopathological features Postoperative complications |
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| 中文摘要: |
| 目的 探讨不同年龄段老年直肠癌患者的临床特征以及术后并发症发生的危险因素。方法 回顾性分析江苏大学附属武进医院普外科2011年5月至2016年5月行直肠癌根治术的272例老年直肠癌患者临床资料。根据年龄,分为普通组（65~74岁）146例,高龄组（≥ 75岁）126例,比较两组的临床特征及术后并发症。应用单因素以及多因素分析法分析术后并发症发生的相关因素。结果 与普通组相比,高龄组的麻醉风险评分（ASA）和Charlson合并症指数（CCI）评分更高,输血以及既往腹部手术史更多。术前合并症中,高龄组的慢性阻塞性肺疾病（COPD）、贫血和消化性溃疡更多、营养情况更差。高龄组的术后伤口感染、肺部感染、尿潴留和营养相关并发症发生率较普通组高,差异均有统计学意义（P<0.05）。单因素分析显示年龄、BMI、ASA评分、CCI评分、贫血、小野寺预后营养指数、高血压和COPD可能与患者术后并发症有关。多因素logistic回归分析显示CCI评分（OR=8.140,P=0.000）和贫血（OR=2.424,P=0.013）是术后并发症发生的独立危险因素。小野寺预后营养指数（OR=0.225,P=0.000）是术后并发症发生的独立保护因素。结论 随着年龄上升,直肠癌患者术前合并症增加、营养状况变差,进而导致术后并发症增加。CCI评分和贫血是术后并发症发生的独立危险因素。 |
| 英文摘要: |
| Objective To investigate the clinicopathological features and risk factors for postoperative complications at different ages in thoseelderly patients with rectal cancer.Methods The clinical and pathologicaldata of 272 elderlypatients with rectal cancer,underwentradicalrectectomy in ourhospital between May 2011 and May 2016, were retrospectively analyzed. According to their ages, all patients were divided into theaged group of 65~74 years old (146 cases) and the advanced group of ≥ 75 years old (126 cases), andthe clinicopathological features, postoperative complications, andscores of anesthesia risk evaluation (ASA scores) and Charlson comorbidityindexes(CCI)between the two groups were compared.The riskfactors associated with postoperative complications were then identified by univariate and multivariate analysis.Results In comparison with the aged group, patients in the advanced group had higher ASA and CCI scores, more times ofblood transfusion and previous abdominal operation. And morepatients with preoperative comorbidity of chronic obstructive pulmonary disease (COPD), anemia and peptic ulcer were found in the advanced group. The pathological features of the advanced group were smaller tumor diameter, higher differentiated degree, earlier Dukes stage, lower distant metastasis rate and R0 resection rate.Thecases of postoperative complications were higher in the advanced group, and the incidence rate of wound infection, pulmonary infection, urinary retention and nutrition-related complications were also higher.Thedifferencesin those indicators mentioned above between the two groups were all statistically significant (P<0.05). Univariate analysis showed that postoperative complications in elderly patients were associated with age, BMI, ASA score, CCI score, anemia, Onodera's prognostic nutritional index(PNI), hypertensionand COPD. Multivariate analysis showed that CCI score(OR=8.140,P=0.000) and anemia(OR=2.424,P=0.013) were independent risk factors for postoperative complications, while Onodera's PNI(OR=0.225,P=0.000) was an independent protective factor for postoperative complications.Conclusion The elderlypatients with rectal cancer would have more preoperative comorbidity and worse nutrition status with increase of theirages, which results in more postoperative complications. |
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