高龄胃癌患者腹腔镜胃切除术安全性与近期疗效

StoSafety and short-term efficacy of laparoscopic gastrectomy for gastric cancer in elderly patients

目的:评价为高龄胃癌患者行腹腔镜胃切除术的安全性及近期疗效。方法:回顾分析2008年7月—2011年12月87例行胃切除术高龄(≥70岁)胃癌患者的临床资料,其中39例行腹腔镜手术(腔镜组),48例行开腹手术(开腹组),比较两组患者的一般情况、手术指标、术后恢复情况、并发症情况及治疗效果。结果:两组患者性别、中位年龄、术前合并症、ASA术前危险度评分、疾病类型均无明显差异(均P>0.05)。与开腹组比较,除平均手术时间无明显差异外(P>0.05),腔镜组术中平均出血量(73 mL vs.309 mL),肠功能恢复时间(4.1 d vs.5.5 d),进流食时间(4.2 d vs.6 d),平均住院时间(19.1 d vs.25.2 d),术后心肺并发症发生率(28.2%vs.56.3%)均明显减少(均P<0.05)。平均随访29个月,腹腔镜组和开腹组患者总生存率分别是57.1%和65.9%(P>0.05)。结论:为高龄患者行腹腔镜胃癌切除术安全可行,可减少患者术中出血量,降低术后心肺并发症的发生率,加快术后胃肠功能恢复。

Objective： To evaluate the safety and short-term effectiveness oflaparoscopic gastrectomy for gastric cancer in elderly patients. Methods： The clinical data of 87 elderly patients （〉70 years） with gastric cancer undergoing gastrectomy from July 2008 to December 2011 were retrospectively analyzed. Of the patients, 39 cases underwent laparoscopic gastrectomy （laparoscopic group） and the other 48 cases underwent traditional open gastrectomy （open surgery group）. The general data, intraoperative variables, postoperative recovery and complications as well as therapeutic efficacy of the two groups were compared. Results： There were no significant differences between the two groups in sex distribution, median age, preoperative comorbidities, preoperative ASA score or disease profiles. Except for the average operative time （no difference was found between the two groups）, the average intraoperative blood loss （73 mL us. 309 mL）, time for bowel function recovery （4.1 d vs. 5.5 d）, time to liquid intake （4.2 d us. 6 d）, average length of hospital stay and incidence of postoperative cardiopulmonary complications （28.2% vs. 56.3%） were all significantly reduced in laparoscopic group compared with open surgery group （all P〈0.05）. The average length of follow- up was 29 months, and the survival rate of laparoscopic group and open surgery group was 57.1% and 65.9%, respectively （P〉0.05）. Conclusion： Laparoscopic gastrectomy for gastric cancer in elderly patients is safe and feasible, and can reduce intraoperative blood loss and postoperative cardiopulmonary complications, as well as promote the recovery of postoperative gastrointestinal function.