老年胃癌患者外科治疗安全性及腹腔镜手术可行性探讨

The safety of surgical treatment and the feasibility of laparoscopic surgery for the elderly patients with gastric cancer

目的探讨老年胃癌患者手术治疗的安全}生及老年胃癌患者腹腔镜手术的可行性。方法回顾性分析手术治疗的65岁以上老年胃癌患者共104例（其中21例行腹腔镜手术）的临床及病理资料，分析不同年龄组及不同手术方式组围手术期并发症发生率及短期疗效等。结果≤75岁患者组（55例）的术前合并疾病发生多于〈75岁组（49例）（77例次、40例次）（X^2=8．03，P〈0．01），以高血压和糖尿病为主，但术后并发症的发生数两组平均（0．45±0．65）次／例、（O．67±0．92）次／例，差异无统计学意义（U=1208．5，P=0．301）。腹腔镜手术组的术前合并疾病、术后并发症、手术时间、术中出血量与开腹手术组相比差异无统计学意义，但腹腔镜手术组较开腹手术组术后住院时间较短及较早进食流质饮食。各组的术后病理情况差异无统计学意义。结论老年胃癌患者在条件允许的情况下仍应积极行手术治疗，并尽可能按规范范围清扫。腹腔镜手术术后患者肠道功能恢复较快，可缩短住院时间。

Objectives To discuss the safety of surgical treatment and the feasibility of laparoscopic surgery for the elderly patients with gastric cancer. Methods The clinical and pathological materials of 104 elderly patients（65 years old or above） undergone surgical treatments retrospectively were analyzed, in order to analysis the postoperative complication incidence and the short-term outcomes in different age groups and different surgical pattern groups. Results There were more preoperative comorbidities in ~〉75 years old group than in 〈75 years old group （especially hypertension and diabetes）, however, the incidence of postoperative complications was not significantly different. There was no difference of preoperative comorbidities, postoperative complications, surgical time or the amouts of blood loss during surgery between the laparoscopic and the traditional surgical groups, while the laparoscopic groups had short period of postoperative hospitalizing and earlier orally intake of fluid diet. There was also no difference of pathological results. Conclusion The elderly patients with gastric cancer should have surgical treatments if the conditions are permitted, and the areas of dissection should be standard as far as possible. The old patient undergone laparoscopic surgery may have a shorter hospitalized period after operation, because their recovery of bowel function is more quickly.