老年胃癌患者手术并发症和非手术相关并发症的治疗对策

Therapy of both surgical complication of gastric cancer Zheng Jiabin and non-surgical related for the elderly

胃癌是最常见的消化道恶性肿瘤之一。随着现代社会人口老龄化日趋严重，更多的老年胃癌患者被诊断并且需要手术治疗。而老年患者身体各器官功能相对低下，共患疾病较多，对麻醉、手术的耐受性较差，因此，增加了手术和术后并发症发生的风险。老年胃癌患者术后常见的手术相关并发症主要包括出血、腹腔感染、吻合口瘘和吻合口破裂、肠梗阻、切口感染和切口延期愈合等；而非手术相关并发症常见的则包括下肢深静脉血栓形成和泌尿系统并发症、呼吸道并发症、麻醉相关并发症（如术后谵妄）等；其他还包括腹腔感染、泌尿系统感染、切口感染、切口延迟愈合、术后胃瘫、胃食管反流、倾倒综合征及胃切除相关性贫血等。因此，针对老年人胃癌，应当从患者的整体情况考虑手术治疗，加强围手术期管理，做好术前宣教，充分评估患者的脏器功能，积极处理基础疾病；术中操作规范，而不是一味追求根治或扩大根治范围；术后给予优质护理、加强镇痛、抗炎、纠正水电解质平衡紊乱和营养支持等治疗。腹腔镜手术和围手术期加速康复外科的实施，有利于减少老年胃癌患者术后并发症的发生率。今后应该开展针对老年胃癌诊疗的前瞻性随机对照研究，为老年胃癌患者的治疗提供高级别的循证医学证据。

Gastric cancer is one of the most common digestive malignant tumors. More and more elderly gastric cancer patients are diagnosed and need to undergo surgical treatment as the population ages. Since the elderly patients decrease in organ function and increase in internal diseases, the tolerance to anesthesia and surgery is poor. As a result, the incidence of surgical and postoperative complications is obviously higher. Complications can be divided into surgical complications and non-surgical related complications. Surgical complications consist mainly of hemorrhage, anastomotic leakage, anastomotic dehiscence and intestinal obstruction, while non-surgical related complications include deep venous thrombosis, pulmonary infection, anesthesia-related complication, abdominal infection, urinary infection, incision infection, poor wound healing, gastroparesis, gastroesophageal reflux disease, dumping syndrome and so on. Hence, we should consider more about the elderly patients＇ physical condition instead of the extent of radical operation. To reduce complications, we should evaluate the organ function and take an active role in underlying diseases before operation. Meanwhile, high quality nursing, powerful analgesia, anti- inflammation, keeping water electrolyte balance and nutrition support are also required postoperatively. Moreover, laparoscopic surgery and enhanced recovery after surgery （ERAS） can reduce the postoperative complications in elderly patients with gastric cancer as well. Further prospective randomized controlled trials about elderly gastric cancer should be carried out in the future, which can provide advanced evidences for treatment.