老年人早期胃癌的外科治疗

Surgical treatment of early stage gastric cancer in elderly patients

目的探讨老年人早期胃癌的临床病理特征、适宜的外科治疗方式及其预后。方法回顾性分析1989年8月至2004年8月间我院收治的83例老年早期胃癌患者临床病理及术后随访资料。结果本组手术切除率为100％,手术死亡率为0,腹腔及切口感染率为0,无吻合口漏。5年牛存率为98％、10年生存率为95％、15年生存率为92％。83例中黏膜癌61例,占74％,无淋巴结转移;黏膜下癌22例,占26％,淋巴结转移4例,多原发癌7例。结论对老年人早期胃癌多癌灶而言,即使病变较小也应作3／4胃切除;癌灶相距远者则应行全胃切除。淋巴结转移、多原发癌及肿瘤侵及黏膜下层是影响预后的重要因素。

Objective To explore the clinicopathological characteristics of early gastric cancer （EGC）, surgical treatment, and prognosis in elderly patients. Methods The clinicopathological and follow-up data in 83 elderly patients with EGC treated by gastrectomy from 1989.8-2004.8 were studied retrospectively. Results All of 83 patients were resectable, and there was no operative death nor surgical complications. The 5-, 10-, and 15- year survival rate was 98% , 95% , and 92% , respectively. Sixty-one cases （74%） were mucosal cancer without lymph node metastasis, 22 cases were submucosal cancer with node metastasis in 4 cases. 7 cases were multiple primary carcinoma. Conclusions Local resection and partial gastrectomy are not suitable for multiple primary carcionoma in elderly patieats with EGC. Subtotal gastrectomy, and total gastrectomy should be the procedure of choice when foci were scattered about. Lymph node metastasis, multiple primary cancer loci and invasion of submucosal layer are all among factors impacting postoperative prognosis.