高龄胃癌患者的围手术期处理(附46例分析)

Perioperative period management in aged patients with gastric carcinoma: 46 cases analyses

目的 探讨高龄胃癌的临床特点和合理的围手术期处理方法。方法 回顾性分析 1 999年 1月～ 2 0 0 3年 9月收治的 4 6例 6 5岁以上的胃癌患者的治疗情况。结果 本组平均发病年龄 73.4岁 ,男女发病比例 5 .5 :1 ,平均病程 4 .2个月 ,早期诊断率为 2 %。术前并存疾病的发生率为 5 4 % ,并存 2种疾病以上占 35 %。根治性切除率 80 % ,姑息性切除率 1 7%。淋巴结转移率 78%。达到根治A级标准 2 0 % ,根治B级标准 6 4 .4 % ,根治C级标准 1 5 .6 %。并发症发生率 34.7% ,同时发生 2种以上并发症占 1 5 .2 %。全组无手术死亡。结论 高龄胃癌患者具有中晚期病例多、合并症多、术后并发症发生率高、手术切除率亦高等特点。术前必须重视全身情况的评估 ,积极治疗合并病 ,制定合理的的手术方式 ,避免不必要的扩大手术范围 ,术后积极预防和治疗可能出现的并发症 ,可以降低手术风险 。

Objective To study the clinical characteristics and the rational management methods of perioperative period in aged patients with gastric carcinoma. Methods The clinical data of 46 patients above 65 years old with gastric carcinoma were retrospectively analyzed in the period of from 1999 to 2003. Results The average age was 73.4 years old, male and female ratio was 5.5:1, the average course of the disease was 4.2 months. Early diagnosis rate was 2%. Preoperative co-exist disease rate was 54%, and the rate of over than two kinds of co-exist diseases was 35%. Radical resection rate was 80%, and nonredicical resection rate was 17%. Lymph node metastasis rate was 78%. The rates attained standard radical resection A, B and C grade were 20%, 64.4% and 15.6% respectively. Complication rate was 34.7%, and the rate of two or more complications happening simultaneously was 15.2%. there was no case who died of operation.Conclusion Aged patients with gastric carcinoma were characterized by most cases in the middle or late stage, more co\|exist diseases, more postoperative complications and higher tumor resection rate. The whole body conditions should be evaluated before operation, the co\|exist diseases should be treated actively. The rational operative mode should be worked out to avoid unnecessary extensive operation range. All kinds of postoperative complications which maybe occur should be prevented and treated actively to reduce the risk of operation and mortality rate.