老年人胃癌的临床症状及病理特征分析

The clinical symptoms and pathological characteristics analysis of gastric carcinoma in the elderly

目的总结分析老年人胃癌的临床症状及病理特征,探讨其发病特点。方法回顾性分析我院2007年1月～2008年6月间住院手术治疗的191例老年人胃癌患者(≥65岁)的临床资料并与同期31例青年胃癌患者比较。结果191例老年人胃癌男女比例为3.9∶1。临床首发症状中,老年组患者以上腹部胀痛﹑吞咽困难为最初临床症状者分别为62.8%﹑18.3%,而青年组分别为80.6%﹑3.2%,两组比较P<0.05,P<0.01。老年组病程较长,病程6个月以上者(34.0%)多于青年组(6.5%),P<0.05。老年组胃癌病理分型为高分化腺癌者(19.4%)显著高于青年组(3.2%),P<0.05;而低分化腺癌老年组(24.1%)低于青年组(41.9%),P<0.05。老年组胃底贲门癌多发(29.8%),高于青年组(12.9%),P<0.05;胃窦部癌老年组(32.5%)低于青年组(51.6%),P<0.05。以上差异均有统计学意义。老年组与青年组肿瘤分期比较差异无统计学意义。结论老年人胃癌患者男性多见,发现时伴随症状较多,病程时间长,多数大于6个月,病变部位较青年患者有向近端胃移行的趋势,中﹑高分化腺癌的发生率明显高于青年患者,但整体病期均较晚,预后差。

Objective To summarize and analyze the clinical symptoms and pathological characteristics of gastric carcinoma in the elderly and to discuss the characteristics of the development of the symptoms. Methods Retrospectively analyze 191 cases of gastric carcinoma on the elderly （≥65 years old）. Results Of all the elderly, the ratio of male to female patients was 3.9 to 1. In the elderly, there were 120 （62.8%） cases of epigastrium pain and 35 （ 18.3% ） cases of sour regurgitation as initial clinic symptom,while of the younger group,the distribution of the symptoms were 25（80.6%） and 1 （3.2%）. This difference has statistics significance. （P〈0.05 ,P〈0.01 respectively）. Course of disease in the elderly lasts longer：the number of cases in the elderly that last more than 6 months is significantly greater than that in younger patients. Distribution of patients in different age groups supports statistics analysis. In terms of pathology distribution,there were 37 （19.4%）cases of well-differentiated adenocarcinoma in aged group, a number that is significantly higher than the younger group,which has 1 case （3.2%）. However, there were 46 cases of poorly differentiated adenocarcinoma in aged group,a number that is lower than the counterpart group. Such difference has statistics significance. Regarding the area of infection,cardia carcinoma is more prevalent in aged group （29.8%）than the younger group （12.9%）. There were 32% of aged group had gastric antrum involvement,compared with 51% in younger group. Such difference also has statistics significance. In terms of staging, there was no significant difference between two groups. Conclusions Of aged patients of gastric carcinoma, male patients are more prevalent. There are many clinic manifestations and the courses of disease last long, namely over six months mostly. The data in younger group suggests that the site of infection has a trend of moving closer to proximal gastric area. The ratio of well-differentiated adenocarcinoma in aged group is significantly higher than in the younger group. However, in general, the discovery of the disease is rather late and the prognosis is poor.