高龄贲门癌根治术经胸腹手术路径的对比研究

COMPARISON OF PATHWAYS FOR ABDOMINAL AND THORACIC OPERATIONS ON ELDERLY PATIENTS WITH CARDIAC CANCER

目的探讨高龄患者贲门癌的外科治疗路径,总结高龄贲门癌患者手术治疗的经验,为临床治疗提供参考。方法选择118例高龄贲门癌切除术患者,随机分为经腹部手术治疗组(观察组)61例和经胸部手术治疗组(对照组)57例。比较两组患者切缘癌阳性率,淋巴结清扫数,手术时间,术中出血量,术后恢复时间,吻合口瘘发生率,心肺并发症发生率,围手术期病死率及术后生存率等指标。结果两组围手术期死亡率、切缘癌阳性率差异无统计学意义(P>0.05),在手术时间、术中出血量、术后恢复时间、吻合口瘘发生率、心肺并发症等方面差异均有统计学意义(P<0.05),观察组的淋巴结清扫数与术后生存率亦优于对照组(P<0.05)。结论经腹部手术治疗高龄贲门癌患者较经胸部手术具有创伤小,对呼吸、循环功能干扰轻,术后恢复快、并发症少等优点,值得临床进一步推广。

Objective To explore the pathways for surgical treatment of elderly patients with cardiac cancer,to sum up the experience of surgery and to provide reference for clinical treatment. Methods 118 cases of ,senile patients were randomly divided into the abdominal operation group （the observation group of 61 cases） and the thoracic operation group （the control group of 57 cases）. The positive rate of cutting edge cancer,the number of lymph node being cleaned, the operation time, the intraoperative blood loss, the postoperative recovery time, the incidence of anastomotic fistula, the incidence of cardiopulmonary compli- cations, the perioperative mortality and the postoperative survival rate of the two groups were compared. Results The perioperative mortality and the positive rate of cutting edge cancer showed no significant difference between the two groups（ P ）0.05）, but the operation time, the intraoperative blood loss,the postoperative recovery time, the incidence of anastomotic fistula, the incidence of cardiopulmonary complications as well as the number of lymph node being cleaned and the postoperative survival rate showed better results in the observation group than in the control group（ P 〈0.05）. Conclusion The abdominal surgical treatment of elderly patients with cardiac cancer has less bad effect on respiratory and circulatory funccomplications.