老年胃癌患者并存疾病的围手术期处理

Perioperative Management of Coexisting Diseases for Elderly Patients with Gastric Cancer

目的探讨老年胃癌患者并存疾病的围手术期处理方法。方法回顾性分析我院于1980年3月至2008年11月期间收治的528例70岁及以上胃癌患者并存疾病围手术期处理的临床资料。结果主要并存疾病为心血管疾病(259例,49.05%)、呼吸系统疾病(161例,30.49%)及糖尿病(72例,13.64%),主要给予调整血压、血糖及改善心、肺、肝、肾功能治疗。术后常见并发症为肠梗阻(10例)、肺部感染(10例)、返流性食管炎(9例)、残胃功能性排空障碍(7例)及吻合口漏(5例)。围手术期死亡10例,包括心肺功能衰竭6例、急性心肌梗死2例,吻合口漏1例及肠梗阻1例。结论老年胃癌患者多并存高血压、支气管炎、糖尿病等疾病。术前全面了解病情,加强对并存疾病的围手术期处理,不仅能降低手术的风险,而且能减少并发症的发生率和降低围手术期死亡率。

Objective To explore the perioperative management of the coexisting diseases for the elderly patients with gastric cancer.Methods The clinical data of perioperative management for coexisting diseases in 528 patients with gastric cancer over 70 years old treated in the First Affiliated Hospital of China Medical University from March 1980 to November 2008 were analyzed retrospectively.Results The main coexisting diseases included cardiovascuclar disease （259 cases,49.05%）,respiratory disease （161 cases,30.49%）, diabetes （72 cases, 13. 64%）.Adjusting blood pressure and blood glucose, improving cardiopulmonary function, and hepatic and renal function were mainly given. The common postoperative complications included intestinal obstruction （10 cases）, pneumonia （10 cases）, reflux esophagitis （9 cases）, functional evacuation disorder of gastric remnant （7 cases）, and anasto motic leakage （5 cases）. Ten patients died during perioperative period： 6 died of heart and lung failure, 2 of acute myocardial infarction, 1 of anastomotic leakage, 1 of intestinal obstruction. Conclusions The common coexisting diseases in the elderly patients with gastric cancer are hypertension, bronchitis and diabetes. Complete assessment of the patient＇s general health before operation and intensive perioperative management of the coexisting diseases not only can decrease the risk of surgical procedures, but also decrease the incidence of complication and perioperative mortality.