不同方式治疗老年局部进展期胃癌的临床疗效与安全性比较

Comparative Study of Clinical Efficacy and Safety of Different Surgical Treatment for Elderly Patients with Locally Advanced Gastric Cancer

目的探讨腹腔镜辅助远端胃大部切除术治疗老年局部进展期胃癌的安全性和疗效,为老年胃癌患者临床治疗提供指导。方法回顾性分析2008年3月至2015年3月234例局部进展期老年(年龄在57岁以上)胃癌患者临床治疗情况,其中传统开腹远端胃大部切除组(传统组)101例,腹腔镜辅助远端胃大部切除组(腹腔镜组)133例,通过SPSS19.0软件进行数据分析,术中及术后各项指标用均数±标准差表示,采用独立t检验;术后并发症、术后复发率和生存率采用χ2检验,P<0.05代表组间差异有统计学意义。结果传统组与腹腔镜组的手术时间、术中出血、淋巴结清扫个数、伤口长度、住院恢复时间以及胃肠功能恢复时间差异均有统计学意义(P<0.05)。两组在并发症发生率、复发率及患者病死率上差异无统计学意义(P>0.05)。结论腹腔镜辅助远端胃大部切除术治疗老年局部进展期胃癌具有手术创伤小、术后恢复快的优点,其并发症发生概率以及治疗效果与传统开腹手术相当,具有广阔的老年局部进展期胃癌临床前景。

Objective To investigate clinical efficacy and safety of laparoscopic gastrectomy for the elderly patients with locally advanced gastric cancer , and to provide guidance for clinical therapy . Methods A retrospective analysis were performed in 234 elderly patients （ aged ≥57 years ） with local advanced gastric cancer , including 101 patients underwent traditional open distal gastrectomy （ traditional group） and 133 patients received laparoscopic distal gastrectomy （ laparoscopic group ） .Statistical analysis were performed by using SPSS19.0 software.Measurement data such as perioperative data were expressed as （x-＆#177;s） and were examined by t test.Count data such as postoperative complications , recurrence rate and survival rate were examined by chi square test , A P value of 〈0.05 was considered as statistically significant . Results There were significant differences between traditional group and laparoscopic group , including operative time , intraoperative bleeding , lymph node dissection , wound length , hospital stay and recovery time of gastrointestinal function （P〈0.05）.There was no significant difference between the two groups in terms of the incidence of complications , recurrence rate and mortality （P〉0.05）. Conclusion Laparoscopic distal gastrectomy for elderly patients with locally advanced gastric cancer has the advantages of minimal trauma, quicker postoperative recovery , with the similar complication rate and clinical outcome as traditional open surgery , with broad clinical prospect in treating locally advanced gastric cancer .