老年人胃癌49例手术治疗分析

Surgical treatment of gastric cancer in elderly patients: A report of 49 cases

目的 探讨老年人胃癌围手术期处理的有关问题及适当的手术治疗方式。方法 回顾性分析1993-1998年我院收治70岁以上老年人胃癌53例,其中施行手术49例的临床资料和手术疗效。结果老年人胃癌起病隐匿,症状多无特异性。术前多数合并有其它疾病;手术证实多数为中晚期胃癌,癌肿多见于幽门窦（77.5％）。大于5cm并累及胃浆膜层（81.6％）。病理检查多分分化型腺癌（73.4％）。49例中30例行胃癌切除术,切除率为61.2％;其中根治性切除8例（17％）,姑息性切除22例（45％）。其它手术19例（胃-空肠吻合术13例,手术探查取活检6例）。围手术期死亡率2.7％。手术后并发症27例（55％）。根治性切除术后5年生存率2.5％,姑息性切除术后五年生存率为零。结论 老年人胃癌有其特殊性,其围手术期处理至关重要,手术根治性切除率低。手术方式应根据病情而定,对早期或中期胃癌争取行D2以内的胃癌根治术。术前充分准备,提高病人手术耐受能力,手术时间以不超过2h为好,术毕常规残留或空肠造瘘,以期减少术后并发症。术后加强管理,并辅以腹腔灌注化疗,对提高病人生活质量,延长生存期有明显帮助。

Objective To discuss the relevant problems in the peri - operative period of the elderly patients with gastric cancer and the choice of appropriate procedures. Methods From 1993 to 1998, 53 eases of gastric cancer were admitted. These patients were more than 70 years old. Forty nine patients were o|>erated on. The clinical history and results of surgical treatment were studied retrospectively. Results The course of disease in these elderly patients suffering from gastric cancer was occult, most of the tumors occurred at the pyloric antrum (77.5 % ). Tumors were usually more than 5 cm in diameter and invadted the serasa. Most of the symptoms were not exclusive. Many patients suffered from other diseases before operation. Most patients were found to be late cases by operation. Adenocarcinom was the most common pathological finding. Among 49 cases, 30 underwent resection, the rate of resection was 61.2% ; 8 cases underwent radical resection (17%) and 22 cases palliative resection (45%). Nineteen patients had other palliative procedures (13 eases of gastrojejunostomy, 6 cases explored and biopsied). The mortality rate during the peri - operative period was 2.7% . Post - operative complications were found in 27 cases (55 % ). Five year survival rate was 62.5 % , while that of those patients receiving palliative resection was 0% . Conclusions The elderly patients suffering from gastric cancer show specific characteristics. The rate of resection is very low. The choice of operative methods should be determined according to the condition of the patients. The operative procedure for early and middle stages of gastric cancer is radical gastrectomy. The elderly patients do not tolerate operation well so the operating time must lie limitted to less than 2 hours. It should be a routine to perform gastrostomy or jejunostomy to reduce postoperative complications. The management during peri- operative period is very important. Intensive post-operative care and intraperitoneal chemotherapy may help to prolong life span of the patients and improve their quality of life.