目的 探討在多學(xué)科協(xié)作(multi-disciplinary team,MDT)診治模式下,新輔助化療聯(lián)合手術(shù)的綜合治療策略在老年人群中應(yīng)用的安全性和臨床差異性。
方法 回顧性研究2007年6月~12月期間就診于四川大學(xué)華西醫(yī)院肛腸外科專業(yè)組的結(jié)直腸癌患者的資料,分析比較老年組(≥60歲)和非老年組( lt;60歲)之間應(yīng)用綜合治療策略的臨床療效差異。
結(jié)果 在術(shù)前指標中,老年組患者合并心血管系統(tǒng)、內(nèi)分泌系統(tǒng)以及其他系統(tǒng)疾病的構(gòu)成比均明顯高于非老年組(P<0.05),其中老年組術(shù)前患有高血壓和糖尿病患者的構(gòu)成比均明顯高于非老年組(P<0.05),其余術(shù)前指標差異無統(tǒng)計學(xué)意義(P gt;0.05)。各項術(shù)中指標的差異在2組間均無統(tǒng)計學(xué)意義(P gt;0.05)。而在術(shù)后指標中,老年組術(shù)后并發(fā)癥發(fā)生率高于非老年組(P<0.05),老年組患者術(shù)后拔除胃管、尿管和引流管的時間和非老年組之間的差異無統(tǒng)計學(xué)意義(P gt;0.05); 同時老年組患者術(shù)后進食時間、經(jīng)肛門排氣/排便時間以及下床活動時間與非老年組比較,差異也無統(tǒng)計學(xué)意義(P gt;0.05)。在化療相關(guān)并發(fā)癥方面,2組間差異也無統(tǒng)計學(xué)意義(P gt;0.05)。
結(jié)論 盡管老年患者可能術(shù)前基礎(chǔ)情況更差、治療難度更大,但新輔助化療聯(lián)合手術(shù)的綜合治療策略并不會導(dǎo)致老年組患者手術(shù)治療的延誤,而且手術(shù)干預(yù)過程中的術(shù)式選擇也并不會受到影響,術(shù)后近期治療效果滿意。因此在老年群體中應(yīng)用該策略是具有一定臨床效果和安全性的。
引用本文: 汪曉東,曾天芳,楊妍姣,邱萌,李立. 多學(xué)科協(xié)作診治模式下老年結(jié)直腸癌患者應(yīng)用新輔助化療聯(lián)合手術(shù)治療的臨床效果. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(10): 773-777. doi: 復(fù)制
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2. | 汪曉東, 曹霖, 羅德云, 等. 多學(xué)科協(xié)作診治模式下運行結(jié)直腸癌綜合治療的臨床對照研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(1)∶63. |
3. | Kobayashi H, Mochizuki H, Sugihara K, et al. Characteristics of recurrence and surveillance tools after curative resection for colorectal cancer: a multicenter study [J]. Surgery, 2007; 141(1)∶67. |
4. | Wedding U, Honecker F, Bokemeyer C, et al. Tolerance to chemotherapy in elderly patients with cancer [J]. Cancer Control, 2007; 14(1)∶44. |
5. | 方鵬騫, 陳茂盛. 人口老齡化的內(nèi)涵界定及世界人口老齡化趨勢 [J]. 國外醫(yī)學(xué)·社會醫(yī)學(xué)分冊, 2001; 18(2)∶61. |
6. | 呂東昊, 汪曉東, 陽川華, 等. 結(jié)直腸腫瘤多學(xué)科協(xié)作診治模式的數(shù)據(jù)庫初期建設(shè)現(xiàn)狀 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(6)∶713. |
7. | Tassinari D, Montanari L, Maltoni M, et al. The palliative prognostic score and survival in patients with advanced solid tumors receiving chemotherapy [J]. Support Care Cancer, 2008; 16(4)∶359. |
8. | Yii MK, Ng KJ. Risk-adjusted surgical audit with the POSSUM scoring system in a developing country. Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity [J]. Br J Surg, 2002; 89(1)∶110. |
9. | 汪曉東, 馮碩, 游小林, 等. 結(jié)直腸腫瘤多學(xué)科協(xié)作診治模式下的隨訪體系建設(shè) [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(6)∶709. |
10. | 汪曉東, 劉春娟, 陳增蓉, 等. 多學(xué)科協(xié)作診治模式下新輔助化療聯(lián)合手術(shù)治療結(jié)直腸癌患者的生存質(zhì)量評估 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(5)∶371. |
11. | Pacella CM, Valle D, Bizzarri G, et al. Percutaneous laser ablation in patients with isolated unresectable liver metastases from colorectal cancer: Results of a phase Ⅱ study [J]. Acta Oncol, 2006; 45(1)∶77. |
12. | Ishikawa M, Nishioka M, Hanaki N, et al. Colorectal resection by a minilaparotomy approach vs. conventional operation for colon cancer. Results of a prospective randomized trial [J]. Hepatogastroenterology, 2007; 54(79)∶1970. |
13. | 汪曉東, 邱萌, 李亞倫, 等. 多學(xué)科協(xié)作診治模式下結(jié)直腸癌不同周期新輔助化療聯(lián)合手術(shù)的方案研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(3)∶210. |
14. | Gozalan U, Yasti AC, Yuksek YN, et al. Peritoneal cytology in colorectal cancer: incidence and prognostic value [J]. Am J Surg, 2007; 193(6)∶672. |
15. | 劉展, 汪曉東, 李立. 多學(xué)科協(xié)作診治模式下的結(jié)直腸外科快速康復(fù)流程 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(2)∶239. |
16. | Olin K, Eriksdotter-Jnhagen M, Jansson A, et al. Postoperative delirium in elderly patients after major abdominal surgery [J]. Br J Surg, 2005; 92(12)∶1559. |
- 1. Morris E, Haward RA, Gilthorpe MS, et al. The impact of the Calman-Hine report on the processes and outcomes of care for Yorkshire’s colorectal cancer patients [J]. Br J Cancer, 2006; 95(8)∶979.
- 2. 汪曉東, 曹霖, 羅德云, 等. 多學(xué)科協(xié)作診治模式下運行結(jié)直腸癌綜合治療的臨床對照研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(1)∶63.
- 3. Kobayashi H, Mochizuki H, Sugihara K, et al. Characteristics of recurrence and surveillance tools after curative resection for colorectal cancer: a multicenter study [J]. Surgery, 2007; 141(1)∶67.
- 4. Wedding U, Honecker F, Bokemeyer C, et al. Tolerance to chemotherapy in elderly patients with cancer [J]. Cancer Control, 2007; 14(1)∶44.
- 5. 方鵬騫, 陳茂盛. 人口老齡化的內(nèi)涵界定及世界人口老齡化趨勢 [J]. 國外醫(yī)學(xué)·社會醫(yī)學(xué)分冊, 2001; 18(2)∶61.
- 6. 呂東昊, 汪曉東, 陽川華, 等. 結(jié)直腸腫瘤多學(xué)科協(xié)作診治模式的數(shù)據(jù)庫初期建設(shè)現(xiàn)狀 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(6)∶713.
- 7. Tassinari D, Montanari L, Maltoni M, et al. The palliative prognostic score and survival in patients with advanced solid tumors receiving chemotherapy [J]. Support Care Cancer, 2008; 16(4)∶359.
- 8. Yii MK, Ng KJ. Risk-adjusted surgical audit with the POSSUM scoring system in a developing country. Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity [J]. Br J Surg, 2002; 89(1)∶110.
- 9. 汪曉東, 馮碩, 游小林, 等. 結(jié)直腸腫瘤多學(xué)科協(xié)作診治模式下的隨訪體系建設(shè) [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(6)∶709.
- 10. 汪曉東, 劉春娟, 陳增蓉, 等. 多學(xué)科協(xié)作診治模式下新輔助化療聯(lián)合手術(shù)治療結(jié)直腸癌患者的生存質(zhì)量評估 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(5)∶371.
- 11. Pacella CM, Valle D, Bizzarri G, et al. Percutaneous laser ablation in patients with isolated unresectable liver metastases from colorectal cancer: Results of a phase Ⅱ study [J]. Acta Oncol, 2006; 45(1)∶77.
- 12. Ishikawa M, Nishioka M, Hanaki N, et al. Colorectal resection by a minilaparotomy approach vs. conventional operation for colon cancer. Results of a prospective randomized trial [J]. Hepatogastroenterology, 2007; 54(79)∶1970.
- 13. 汪曉東, 邱萌, 李亞倫, 等. 多學(xué)科協(xié)作診治模式下結(jié)直腸癌不同周期新輔助化療聯(lián)合手術(shù)的方案研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(3)∶210.
- 14. Gozalan U, Yasti AC, Yuksek YN, et al. Peritoneal cytology in colorectal cancer: incidence and prognostic value [J]. Am J Surg, 2007; 193(6)∶672.
- 15. 劉展, 汪曉東, 李立. 多學(xué)科協(xié)作診治模式下的結(jié)直腸外科快速康復(fù)流程 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(2)∶239.
- 16. Olin K, Eriksdotter-Jnhagen M, Jansson A, et al. Postoperative delirium in elderly patients after major abdominal surgery [J]. Br J Surg, 2005; 92(12)∶1559.