• 1. 四川大學(xué)華西醫(yī)院肛腸外科（成都 610041）2. 四川大學(xué)華西醫(yī)院腫瘤科（成都 610041）;

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(biāo)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(biāo)差異無(wú)統(tǒng)計(jì)學(xué)意義(P gt;0.05)。各項(xiàng)術(shù)中指標(biāo)的差異在2組間均無(wú)統(tǒng)計(jì)學(xué)意義(P gt;0.05)。而在術(shù)后指標(biāo)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(shí)間和非老年組之間的差異無(wú)統(tǒng)計(jì)學(xué)意義(P gt;0.05); 同時(shí)老年組患者術(shù)后進(jìn)食時(shí)間、經(jīng)肛門排氣/排便時(shí)間以及下床活動(dòng)時(shí)間與非老年組比較，差異也無(wú)統(tǒng)計(jì)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(wú)統(tǒng)計(jì)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(huì)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(guò)程中的術(shù)式選擇也并不會(huì)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(guó)普外基礎(chǔ)與臨床雜志, 2008, 15(10): 773-777. doi: 復(fù)制

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(yùn)行結(jié)直腸癌綜合治療的臨床對(duì)照研究 [Ｊ]. 中國(guó)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(shì) [Ｊ]. 國(guó)外醫(yī)學(xué)·社會(huì)醫(yī)學(xué)分冊(cè), 2001; 18(2)∶61.
6. 　呂東昊, 汪曉東, 陽(yáng)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(kù)初期建設(shè)現(xiàn)狀 [Ｊ]. 中國(guó)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(guó)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(píng)估 [Ｊ]. 中國(guó)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(guó)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(guó)普外基礎(chǔ)與臨床雜志, 2007; 14(2)∶239.
16. 　Olin K, Eriksdotter-Jnhagen M, Jansson A, et al. Postoperative delirium in elderly patients after major abdominal surgery [Ｊ]. Br J Surg, 2005; 92(12)∶1559.
  1. 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. 2. 　汪曉東, 曹霖, 羅德云, 等. 多學(xué)科協(xié)作診治模式下運(yùn)行結(jié)直腸癌綜合治療的臨床對(duì)照研究 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(1)∶63.
  3. 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. 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. 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(shì) [Ｊ]. 國(guó)外醫(yī)學(xué)·社會(huì)醫(yī)學(xué)分冊(cè), 2001; 18(2)∶61.
  6. 6. 　呂東昊, 汪曉東, 陽(yáng)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(kù)初期建設(shè)現(xiàn)狀 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007; 14(6)∶713.
  7. 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. 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. 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(guó)普外基礎(chǔ)與臨床雜志, 2007; 14(6)∶709.
  10. 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(píng)估 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(5)∶371.
  11. 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. 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. 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(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(3)∶210.
  14. 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. 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(guó)普外基礎(chǔ)與臨床雜志, 2007; 14(2)∶239.
  16. 16. 　Olin K, Eriksdotter-Jnhagen M, Jansson A, et al. Postoperative delirium in elderly patients after major abdominal surgery [Ｊ]. Br J Surg, 2005; 92(12)∶1559.