高龄患者腹腔镜胃癌手术围手术期处理体会

Perioperative management for elderly patients undergoing laparoscopic gastric surgery

目的探讨高龄患者腹腔镜胃癌手术围手术期处理的方法及高龄患者行腹腔镜胃癌手术的安全性、可行性。方法回顾分析该院普外科2009年6月至2014年4月间收治的280例高龄(≥70岁)胃癌患者的临床资料,其中163例行腹腔镜手术(腹腔镜组),117例行开腹手术(开腹组),比较两组患者的一般资料及术中、术后相关指标。结果两组患者年龄、性别、临床病理分期、病理类型、肿瘤部位、手术方式和术前合并症等比较差异无统计学意义(P>0.05)。与开腹组比较,腹腔镜组手术时间延长,但差异无统计学意义(P>0.05),而腔镜组术中出血量少、术后拔胃管时间、下床活动时间、进食时间、通气时间、住院时间均短于开腹组,并发症发生率较开腹组降低,差异存在统计学意义(P<0.05)。结论合理的围手术期处理是保证高龄患者腹腔镜胃癌手术成功的关键。重视术前合并症的处理,术中贯彻微创观念和使用微创外科技术,采取个体化手术方式,积极防治术后并发症,腹腔镜胃癌手术在高龄患者中的应用是安全可行的,且相对于传统开腹手术优势明显。

Objective To explore perioperative management for elderly patients undergoing laparoscopic gastric surgery and safety and feasibility of laparoscopic gastric surgery for elderly patients .Methods The clinical data of 280 elderly patients（≥70 years） with gas-tric cancer undergoing gastrectomy from June 2009 to April 2014 were retrospectively analyzed .Of the patients ,163 cases underwent laparoscopic gastrectomy （ laparoscopic group ） and the other 117 cases underwent traditional open gastrectomy （ open surgery group ） . The general data ,intraoperative and postoperative variables of the two groups were compared .Results There were no significant differ-ences between the two groups in age ,sex distribution,clinical and pathological staging ,pathological type ,tumor location,mode of opera-tion and preoperative complications （P＆gt;0.05）.The average operative time was longer in laparoscopic group compared with open sur -gery group,but there were no significant differences （P＆gt;0.05）.The average intraoperative blood loss ,pull tube time,postoperative am-bulation time,feeding time,ventilation time,average length of hospital stay and incidence of postoperative cardiopulmonary complica -tions were all significantly reduced in laparoscopic group compared with open surgery group .There were significant differences （ P＆lt;0.05）.Conclusions Reasonable perioperative management is critical to ensure the success of laparoscopic gastric surgery for elderly patients.As long as emphasis is made on treatment of preoperative complications ,use of minimally invasive surgical techniques ,take in-dividual operation mode ,and prevention of postoperative complications in elderly patients with gastric cancer ,laparoscopic gastric sur-gery is safe and feasible for elderly patients and has obvious advantages compared with traditional open gastrectomy .