老年胃癌患者的外科治疗和围手术期处理

Surgical treatment and perioperative management for gastric cancer in the elderly

目的探讨老年人胃癌的临床特点和治疗方法。方法回顾性分析我院1971～2002年外科收治的年龄超过或等于70岁的452例胃癌患者的临床资料。结果主要临床表现为上腹疼痛、胞胀或不适(74.3%),以及消瘦(53.3%)和食欲下降(47.1%)。临床Ⅲ、Ⅳ期患者占63.9%。413例患者予以手术治疗,胃切除316例(76.5%),其中根治性切除231例(73.1%),姑息性切除85例(26.9%)。并存有重要器官慢性病变238例(52.7%),出现术后并发症194例(47.0%)。手术患者5年生存率32.9%,其中胃切除患者为43.0%,根治性切除患者为57.9%,姑息性切除患者为2.7%。结论老年胃癌患者多为临床Ⅲ、Ⅳ期;术后并发症发生率高。应提高早期诊断率;适宜的手术治疗是提高老年胃癌患者生存率的关键,但应做好围手术期处理。

Objective To explore the clinical features and treatment methods of gastric cancer in elderly patients. Methods Clinical data of 452 patients older than 70 years with gastric cancer from 1971 to 2002 were analyzed retrospectively. Results The main clinical manifestations were upper abdominal pain, distention or upset (74.3%), emaciation (53.3%) and loss of appetite (47.1%). The patients with clinical Ⅲ,Ⅳstage accounted for 63.9 percent. Four hundred and thirteen patients received surgical treatment. Three hundred and sixteen cases underwent gastrectomy (76.5%), including radical resection in 231 cases(73.1%) and palliative resection in 85 cases(26.9%). Two hundred and thirty eight patients had coexistent chronic diseases of important organs, and 194 patients had postoperative complications. The 5 year survival rate was 32.9%in the patients with surgical treatment, 43.0%with gastrectomy, 57.9%with radical resection and 2.7%with palliative resection. Conclusions The majority of elderly patients with gastric cancer belong to clinical Ⅲ, Ⅳstages. The morbidity rate is high. Proper surgical treatment is the key to increase the survival rate of elderly gastric cancer patients. Perioperative management is important to increase operative success and reduce postoperative complications.