70岁以上胃癌患者根治性手术的危险因素分析

Analysis of the risk factors of radical operation in patients with gastric carcinoma over 70 years of old

目的探讨70岁以上胃癌患者根治性手术的危险因素。方法回顾分析安徽医科大学第三附属医院2008年8月至2015年8月242例接受胃癌手术的70岁以上患者的临床资料,并对可能影响短期手术效果的危险因素进行分析。结果 242例患者合并基础疾病发生率高(56.2%);术后并发症发生率高(96例,39.7%),最常见的并发症是肺部感染、胸腔积液和切口感染。多因素分析年龄≥76岁、合并基础疾病、联合脏器切除、手术时间≥240 min、术前血红蛋白<80 g/L是70岁以上胃癌患者的手术危险因素。结论对于高龄胃癌患者外科医师不要放弃根治机会,但要重视患者年龄、合并基础疾病的处理,提高手术技能,缩短手术时间,重视围手术期处理和多学科协作,积极预防和处理并发症,高龄胃癌患者行胃癌D2根治术仍然是安全的。

Objective To analyze the risk factors of radical operation in patients with gastric carcinoma over 70 years of old. Methods A total of 242 patients（ ≥70 years） with gastric cancer who underwent radical gastrectomy in the third affiliated hospital of An Hui Medical University from August 2008 to August 2015 were chosen accordingly. A retrospective analysis of correlation between surgical outcomes and age was performed.Results The multi-consolidated basis rate（ 56. 2%） and postoperative complications rate（ 39. 7%） were high in patients（ ≥70 years） with gastric carcinoma. The most common complications were pulmonary infection,pleural effusion and wound infection. Multivariate analysis revealed that for patients age≥76 years,the multi-consolidated basis combined resection,operation time≥240 min,preoperative HB 〈80 g / L to be associated with surgical complication. Conclusions Considering the elderly patients with gastric carcinoma,it is not advisable for surgeons to give up the chance of radical operation on them. There are some conditions that need doctors＇ concerns,such as patients＇ age,combined treatment of basic diseases,improved operating skill,shorten the operation time,pay attention to peri-operative treatment and multidisciplinary collaboration,active prevention and treatment of complications. It is still safe for elderly patients with gastric cancer who underwent D2 radical gastrectomy.