352例老年胃癌手术治疗及围手术期处理

Surgical treatment and perioperative management for 352 cases of gastric cancer in the elder

目的 探讨老年患者胃癌的临床特点、手术方式及围手术期处理。方法 回顾性分析手术治疗的年龄≥70岁的 352例胃癌患者临床资料。结果 主要临床表现为上腹部疼痛、饱胀或不适 ( 81 5% )、食欲下降 ( 53 1% )和消瘦(44 9% ),其临床Ⅲ、Ⅳ期患者占 63 9%;其中根治性切除272例(77 3% ),姑息性切除 48例 ( 13 6% ),联合脏器 (脾脏、胰体尾、横结肠或肝左外叶 )切除 32例 ( 9 1% ),行捷径、造瘘或剖腹探查术 32例 ( 9 1% ),Roux en Y已成为主要消化道重建方式;并存重要器官慢性病变 242 例(68 8% ),出现术后并发症 172例(48 9% ); 5年生存率:根治性切除为 44 2%,姑息性切除 3 4%,行捷径、造瘘或剖腹探查为 0。结论 老年胃癌患者多为临床Ⅲ、Ⅳ期;多并存有重要器官慢性病变;手术治疗是提高老年胃癌患者生存率的关键,但应做好围手术期处理。

Objective To explore the clinical features, treatment methods and the perioperative management of gastric cancer in elderly patients. Methods Clinical data of 352 patients older than 70 years with gastric cancer from 1994 to 2003 were analyzed retrospectively. Results The main clinical manifestations were upper abdominal pain, distention or upset (81 5%), loss of appetite (53 1%) and emaciation (44 9%). The patients with clinical Ⅲ,Ⅳstage accounted for 63 9 percent.352 patients received surgical treatment.320 cases underwent gastrectomy (90 9%), including radical resection in 272 cases (77 3%)and palliative resection in 48 cases (13 6%). 242 patients had coexistent chronic diseases of important organs, and 172 patients had postoperative complication. The 5 years survival rate was 44 2% in the patients with radical resection and 3 4% with palliative resection. Conclusion The majority of elderly patients with gastric cancer belong to clinical Ⅲ,Ⅳ stages. Proper surgical treatment is the key to increase the survival rate of elderly gastric cancer patients. Perioperative management is important to increase operative success and reduce postoperative complications