70岁以上进展期贲门癌患者103例临床分析

Clinical analysis of 103 senile patients older than 70 years with advanced cardiac cancer

目的探讨70岁以上进展期贲门癌患者的临床特点与外科治疗。方法对1991～2003年收治的103例70岁以上及小于70岁的进展期贲门癌患者的临床资料进行分析比较。结果两组患者在肿瘤病理分型、分期、手术方式方面比较,差异无统计学意义(P>0.05);临床症状和术前并存疾病比较,差异有统计学意义(P<0.01)。大于70岁组以进食梗阻感为主要症状(64%),术前并存心血管系统和肺部疾病者分别占63%、34%,有贫血和低蛋白血症者占68%。两组经腹全胃切除术分别占78%和73%(P>0.05)。术后发生肺部感染者两组差异无统计学意义(P>0.05)。两组手术死亡率分别为3%、2%(P>0.05)。结论对70岁以上进展期贲门癌患者,采用经腹全胃切除是安全的术式;术前应对患者重要脏器功能进行全面检测,术后尤应重视并发症的预防。

Objective To investigate clinical characteristics and rational surgical therapy for cardiac cancer patients over 70 years. Methods From 1991 to 2003,clinical data of 206 patients with advanced cardiac cancer were collected and analyzed. The patients were divided into two groups as the group of patients over 70 years old(103 cases) and the group younger than 70 years old(100 cases). Results There were no significant differences in tumor pathologic types,tumor staging and surgical approaches(P >0.05),but there were significant differences in clinical symptoms and coexistent diseases between two groups(P< 0.01). Patients over 70 years had main clinical symptom of dysphagia in 64%,coexistent heart and lung disease in 63%and 73%,respectively; anaemia and hypoproteinemia in 63%and 34%,respectively. Total gastrectomy via abdomen was performed in 78%and 73%of two groups respectively(P >0.05). There was no significant difference in postoperative complications such as pulmonary infection between the two groups. The operative mortality was 3%and 2%in two groups respectively(P >0.05). Conclusions Total gastrectomy via abdomen is a safe approach for advanced cardiac cancer patients older than 70 years. The function of vital organs should be examined before operation. It is important to take certain measurements to prevent patients from postoperative complications.