年龄对胃癌手术短期临床结局影响的回顾性分析

Retrospective analysis of the impact of age on the short-term clinical outcomes of gastric cancer surgery

目的探讨年龄对胃癌手术患者短期临床结局的影响。方法回顾性分析2008年5月到2012年9月收治的432例胃癌患者的临床病理资料,根据年龄将所有纳入患者分为老年组（≥60岁）230例和对照组（〈60岁）202例,应用χ^2检验、独立样本t检验及非参数检验对各分组患者的临床资料进行比较,用多因素Logistic回归分析各危险因素与术后30 d内发生并发症的关系。结果两组术前合并症数量、ASA评分、第一次排气时间明显不同,差异有统计学意义（P〈0.05）。老年组术后肺部感染率为3.91%（9/230）高于对照组的0.99%（2/202）,差异接近有统计学意义（χ^2=3.703,P=0.054）。老年组术后并发症的发生率为24.78%（57/230）,略高于对照组的22.28%（45/202）,差异无统计学意义（χ^2=0.374,P=0.541）。而老年患者术后需要ICU监护的比例为14.78%（34/230）,显著高于对照组的1.98%（4/202）（χ^2=21.972,P〈0.01）。结论年龄不是影响患者术后并发症的独立危险因素。通过术前风险评估,术中安全监护,对于老年胃癌患者行肿瘤根治术是安全可行的。

Objective To investigate the impact of age on the short- term clinical outcomes of patients with gastric cancer.Methods The clinical data of four hundred and thirty-two gastric cancer patients who received surgical therapy between May 2008 and September 2012 were retrospectively analyzed.Among them,230 patients aged over 60 years were set as old age group,and the other 202 patients were set as control group.The clinical outcomes occurring within 30 days after operation were compared between the two groups by chi.square test,independent-samples t test or non-parametric test.Multivariate Logistic regression analysis was performed to identify independent factors.Results There were significant differences in the number of preoperative comorbidities,the scores of ASA,the first flatus time（P0.05）between the two groups.The rate of postoperative pulmonary infection of elderly patients was higher than that of control group,though the difference was not statistically significant（3.91% vs 0.99%,χ^2=3.703,P=0.054）.The incidence rate of postoperative complication was 24.78%（57/230）,which was slightly higher than that of control group（22.28%,45/202）,and the difference was not statistically significant（χ^2=0.374,P=0.541）.The ratio of elderly patients who needed ICU immediately after surgery was 14.78%（34/230）,which was significantly higher than that of control group（1.98%,4/202）（χ^2=21.972,P0.01）.Conclusions Age is not an independent risk factor that influences postoperative complication of gastric cancer.It is feasible and safe to perform radical gastrectomy on elderly patients of gastric cancer for safety monitoring during the operation.