高龄胃癌患者腹腔镜手术安全性的评价

Safety evaluation of laparoscopic surgery in the treatment of elderly patients with gastric cancer

目的:评价腹腔镜辅助胃癌根治术在80岁及以上胃癌患者治疗中的安全性。方法:回顾性分析接受胃癌根治术的80岁及以上患者76例,按手术方式分为腹腔镜组(n=14)和开放组(n=62),标化两组间的基线资料,以并发症的实际发生率/预测发生率(O/E)衡量手术安全性,比较术后并发症发生率和术后康复的差异。结果:腹腔镜组并发症发生率为42.9%,无Ⅲ级以上并发症;开放组并发症发生率为62.9%,Ⅲ级以上并发症12例。腹腔镜组O/E值为0.91,开放组O/E值为0.98。剔除开放组高风险病例后,腹腔镜组在胃管留置时间、腹腔引流管留置时间、首次进食时间、术后住院时间等方面,腹腔镜组均明显短于开放组(P<0.05或P<0.01)。两组间在住院费用方面没有明显差异(P>0.05)。结论:腹腔镜辅助胃癌根治术在高龄胃癌患者中是安全的,术后恢复快,并发症少。

Objective:To evaluate the safety of laparoscope-assisted radical gastrectomy for cancer of elderly patients with gas-trie cancer aged>80years.Methods:76elderly patients with gastric cancer aged>80years and December2014were retrospectively analyzed.The patients were divided into lapatoscope group(n,=14)and laparotomy group(n,=62)according to surgical methods.The baseline data were standardized between two groups,and observed/expected(0/E)occurrence rate of complications was used to evalu-ate the surgical safety.And the difference in the ratio of postoperative complications and postoperative rehabilitation were compared be-tween two groups.Results:In laparoscope group,the ratio of complications was42.9%,and no one had complications above class III.In laparotomy group,the ratio of complications was62.9%,and12patients had complications above class III.The0/E value was0.91in laparoscope group and0.98in laparotomy group.After the patients with high risk were rejected in laparotomy group,laparoscope group was evidently shorter than laparotomy group in the indwelling time of gastric catheter,the indwelling time of abdominal drainage cathe-ter,initial time of food intake,and the length of postoperative hospital stay(P<0.05and P<0.01).There was insignificant difference between two groups in the hospitalization cost(P>0.05).Conclusion:Laparoscope-assisted radical gastrectomy for cancer is safe in the treatment of elderly patients with gastric cancer,which is fast in postoperative rehabilitation and less in complications.