充分重视与老年胃肠道癌肿患者外科治疗相关的关键因素

Full attention to several key issues in surgical treatment for the elderly patients with gastrointestinal cancer

随着我国人口老年化的发展。老年人群体胃肠道癌肿的发病率呈现逐渐上升的趋势。75岁以上老年人胃肠道癌肿的发病风险是普通人群的5—6倍．而死亡风险更达到7～8倍之多：与非老年人群体相比较，≥75岁老年人群体胃癌发病率下降并不明显，总体结直肠癌的发病率攀升更快。故应重视对老年人群体的防癌普查，做到及时发现、及时诊断和及时治疗。由于老年患者病情隐匿，实际病程较长，一旦临床作出诊断，癌肿多属于中晚期，临床病理分期以Ⅲ或Ⅳ期多见；但所患癌肿细胞分化程度较高。乳头状或管状腺癌多见，胃癌中Lauren肠型、BorrmannⅡ或Ⅲ型居多．病理生物学特征相对较好。故老年人患者与肿瘤相关的预后应该不亚于非老年人患者。与非老年人患者相比．老年胃肠道癌肿患者往往同时患有包括高血压、糖尿病、心脏病、神经系统疾病、呼吸道疾病和肾脏疾病等其他系统或脏器的器质性疾病，并随着年龄的增长，共患疾病的数量和严重程度也相应发展，因此，手术治疗风险和并发症发生率均较高。因此，临床上必须充分重视对老年胃肠道癌肿患者的诊断，高度重视对老年胃肠道癌肿患者围手术期的处理，积极采取防范手术直接并发症与共患疾病并发症并重的策略。微创手术仍然应该成为治疗老年人胃肠道癌肿的首选，但对施行联合脏器切除的扩大根治术应持十分谨慎的态度．需尽量缩短麻醉和手术的时间，避免过度进行淋巴结清扫，减少出血量。通过给予老年人胃肠道癌肿患者积极、适度与合理的外科综合治疗，仍然可望达到理想的治疗效果。

With the development of population aging in our country, the incidence of gastrointestinal cancer is increasing. The risk of developing gastrointestinal cancer in elderly over 75 years was 5 - 6 times and the risk of death of gastrointestinal cancer was 7 - 8 times of the general population. As compared to non-elderly, the incidence of gastric cancer was not decreased obviously but the total incidence of colorectal cancer was increased more quickly. Therefore, screening of gastrointestinal cancer should be performed in the elderly for early discovery, diagnosis and treatment. Because of the insidious onset of the illness in elderly patients, gastrointestinal cancers are mostly diagnosed at advanced or late stage （stage Ⅲ or Ⅳ ）. Well differentiated cancer is more common, such as papillary or tubular adenocarcinoma. Lauren type, Borrmann Ⅱor Ⅲare more common in gastric cancer, which are relatively favorable. Compared with non-elderly patients, many elderly patients also suffer from comorbid diseases with higher operation risk and postoperative complication rates. Therefore, we must pay great attention to the perioperative management and the surgical operation for the elderly patients. In this paper, several key issues involved the development trend of incidence and mortality of gastrointestinal cancer, the clinicopathological characteristics, the comorbidity and surgical treatment in the elderly patients with gastrointestinal cancer will be elaborated, aiming at promoting further attention to the clinical therapeutic strategies, management measures and prognostic factors for the elderly patients with gastrointestinal cancer.