老年胃癌患者外科治疗分析

Clinical significance analysis of radical operation for gastric cancer in elderly patients

目的分析根治术治疗老年胃癌的疗效以及影响疗效的相关因素。方法以216例老年胃癌患者为研究对象，根据手术方式分为远端胃切除根治术组和近端胃切除根治术组，两组患者各108例。对比两组患者的近期疗效、术中、术后恢复情况、淋巴结清扫数以及影响远期生存率的因素。结果两组患者平均手术时间、术中出血量、淋巴结清扫数、并发症发生率、3年生存率比较差异无统计学意义（241．8±40．2）min和（244．7±39．7）min、（299．5±114．9）ml和（273．8±121．4）ml、（28．4±9．4）个和（27．7±9．1）个、13．0％（14／108）和14．0％（15／108），46．9％和47．5％，P〉0．05；多因素分析显示TNM分期（OR=1．536）、淋巴结转移（OR=0．739）、浸润深度（OR=1．534）与化疗方案（OR=1．337）是影响术后3年存活率的危险因素。结论外科治疗老年胃癌的疗效显著，TNM分期、淋巴结转移、浸润深度、肿瘤直径与化疗方案和患者术后生存质量有关。

Objective To analyze the therapeutic effect of the radical operation for gastric cancer in elderly patients and to investigate relevant factors affecting the efficacy Methods 216 cases of elderly patients with gastric cancer were divided into two groups： radical distal- and proximalgastrectomy group （n = 108, each）. The therapeutic effect in the near future, intraoperative and postoperative recovery, numbers of lymph nodes resection as well as factors affecting the long-term survival rate were compared between two groups. Results The radical distal-versus proximalgastrectomy group showed that the mean operation time was （ 241.8 ± 40.2） min vs. （ 244.7 ± 39.7 ） min,blood loss was（299.5±114.9）ml vs. （273.8±121.4）ml,the number of lymph node dissection was（28.4±9.4） vs. （ 27.7 ± 9.1 ） particles, the complication rate was [14/108 （ 13.0 % ）] vs. [15/108 （14.0% ） ], 3-year survival rate was （46.9 % ） vs. （47.5% ）, without statistically significant differences （all P〉0.05）. Multiple regression analysis showed that TNM stage （OR = 1. 536）, lymph node metastasis （OR = 0. 739 ）, cancer infiltration depth （ OR = 1. 534 ） and chemotherapy regimens （ OR 1. 337）are risk factors for the postoperative 3-year survival rate. Conclusions Surgical treatment of elderly patients with gastric cancer is significantly effective, TNM stage,lymph node metastasis, depth of invasion,tumor size and the chemotherapy regimens are closely associated with the life quality of patients.