老年人胃癌的围手术期处理(附181例报告)

The perioperative management for the elderly patients with gastric carcinoma

目的探讨老年胃癌患者的围术期处理经验。方法回顾性分析1996年7月至2007年6月181例60岁以上接受手术治疗的胃癌病例。结果181例患者中合并糖尿病27例,慢性支气管炎37例,阻塞性通气障碍12例,贫血79例,低蛋白血症28例,高血压病63例,冠心病72例。无术前死亡病例,术后出现并发症147例次:胰漏1例,腹水形成13例,伤口裂开1例,伤口感染3例,心衰2例,心绞痛3例,血压升高79例,心律失常57例,血糖升高34例,肺部感染18例,急性胰腺炎1例;死亡3例(1.66%)。结论术前合并症增加了手术的风险性,但术前全面了解病情,加强对其围手术期处理可提高手术的安全性,降低手术死亡率和并发症发生率。

Objective To explore the perioperative management for the elderly patients with gastric carcinoma. Methods From July 1996 to June 2007, the experience of surgical treatment for gastric carcinoma in 181 patients over 60 years old was analyzed retrospectively. Results The coexisting diseases included hypertension （63 cases）, coronary heart disease （72 cases） , chronic bronchitis （37 cases）, cardiac insufficiency （ 1 case）, cardiac arrhythmias （38 cases）, diabetes （27 cases）, chronic obstructive pulmonary disease （ 12 cases）, anemia （ 79 cases）, hypoproteinemia （ 28 cases）. Post - operative complications：cardiac insufficiency （2 cases） , wound infection （3 cases） , wound dehiscence （1 case） , hypertension （79 cases）, cardiac arrhythmias （ 57 cases ）, angina pectoris （ 3 cases）, lung infection （ 18 cases）, acute pancreatitis （ 1 case）. Three cases （ 1.66% ） died postoperatively. Conclusion The coexisting diseases increase the risk of surgical procedures, but complete assessment of the patient＇s general health and intensive perioperative management of the coexisting diseases can increase the success rate of operation and decrease the operative mortality and incidence of complications.