关键词: 老年病人, 结直肠癌, 延迟性术后肠麻痹, 腹腔镜手术, 危险因素

Abstract: Objective To explore the risk factors and possible preventive measures of delayed postoperative intestinal paralysis (PPOI) in elderly (aged ≥75 years) patients with colorectal cancer.Methods This retrospective study included 333 patients with CRC who underwent laporascopic resection in General Department of Beijing Chaoyang Hospital from June 2016 to August 2023.There were 126 patients were enrolled in PPOI group and 207 patients were enrolled in non-PPOI group.The perioperative clinical characteristics of the patients were compared between PPOI group and non-PPOI group,and the risk factors of PPOI and potential preventive measures for them were investigated using-Logistic-regression.Results The incidence of PPOI after laparoscopic surgery in elderly patients with colorectal cancer was 37.84%. The ages of the PPOI group and the non-PPOI group were (82.60±3.587) years and (80.38±3.847) years respectively. The rates of primary enterostomy during the operation were 20.63% and 9.66%,respectively, and the preoperative combined nutritional risks were 53.97% and 20.77%,respectively.The preoperative serum albumin levels were lower, which were (35.32±3.77) g/L and (38.36±3.91) g/L,respectively, and the preoperative hemoglobin levels were (104.47±20.31) g/L and (110.33 ±20.27) g/L,respectively. The intraoperative blood loss was (140.48±130.65) ml and (98.26±56.45) ml,respectively. The patients who received enhanced recovery after surgery (ERAS) measures during the perioperative period were 14.29% and 75.85%,respectively. There was a statistically significant difference between the two groups (P<0.05).The Logistic analysis showed that the risk factors for elderly patients with PPOI including increased age ,preoperative nutritional risk ,low preoperative albumin ,increased intraoperative blood loss.Moreover,the implementation of ERAS protocols  including preoperative nutritional support ,multimodal low-opioid anesthesia,gastric tube removal  and ground activity  early after surgery may be the protective factors of PPOI.Conclusion The risk factors of PPOI for colorectal patients older than 75 years including increased age,preoperative nutritional risk,low preoperative albumin,increased intraoperative blood loss.The ERAS protocols including preoperative nutritional support,multimodal low-opioid anesthesia,gastric tube removal and ground activity early after surgery may be useful to prevent the occurrence of PPOI for elderly patients with colorectal cancer.

Key words: elderly patients, colorectal cancer, prolonged postoperative ileus, laparoscopic resection surgery, risk factors