老年胃癌患者行微创根治术的临床研究

Clinical Study of Elderly Patients with Minimally Invasive Surgery for Radical Gastrectomy

目的观察老年胃癌患者行微创根治术的安全性和临床疗效.方法回顾性分析在上海市松江区中心医院行微创根治术的282例胃癌患者,根据年龄分为2组:高龄组78例,年龄大于等于70岁;非高龄组204例,年龄低于70岁.比较2组患者临床病理特征、手术情况和术后并发症发生率.结果高龄组患者ASA评分差于非高龄组(P<0.001),且合并糖尿病(P=0.024)、高血压(P<0.001)患病率明显高于非高龄组.各组患者平均手术时间、术后输血率、术中失血量、中转开腹率、术后排气时间以及术后住院时间等指标均无显著差异(P>0.05).高龄组和对照组相比,术后总并发症和手术相关并发症发生率无明显差别(P>0.05),但高龄组术后内科系统并发症发生率为11.54%,显著高于对照组的1.96%(χ2=11.771,P=0.001).高龄组和非高龄组术后30 d内死亡率分别为2.56%和1.47%,差异无统计学意义(P>0.05).结论微创根治术并未增加老年患者的手术相关风险,但由于其合并多种内科疾病,术后内科并发症发生率明显提高.

Objective To observe the safety and clinical efficacy of minimally invasive surgery for radical gastrectomy in elderly patients with gastric cancer.Methods The clinical data of 282 patients with gastric cancer who received minimally invasive surgery for radical gastrectomy were retrospectively analyzed.The patients were divided into two groups by age.The elderly group（n=78,age≥70 years） and the non- elderly group（n=204,age70 years）.We compared the differences in the pathological features, operative procedure and postoperative recovery of patients between the two groups.Results The elderly group had a worse ASA score（P〈0.001） and higher prevalence of diabetes（P=0.024） and hypertension（P〈0.001）.No statistical differences in the average operative time, postoperative transfusion rates, intraoperative blood loss, laparotomy rate, time to first flatus and postoperative hospital stay were observed between groups（P〉0.05）.The incidence of medical complications in the elderly group was 11.54%, higher than that in the non- elderly group, which was 1.96%（χ2 =11.771, P =0.001）.But no differences in total postoperative complications or surgery- related complications were observed（P〉0.05）.30 d postoperative mortality in the elderly and non- elderly group was 2.56% and 1.47% respectively,with no significant difference observed（P 0.05）.Conclusion Minimally invasive surgery for radical gastrectomy does not increase the risk of surgery- related complications in elderly patients with gastric cancer,but increases the risk of medical complications after operation.