老年胃癌患者手术风险因素分析

目的 总结分析老年胃癌患者的临床特点和手术风险性.方法 回顾性分析2006年1月至2008年12月607例胃癌手术患者的临床资料,其中年龄＞65岁的老年患者267例,将年龄≤65岁患者340例作为对照组.所有患者均由同一组手术人员完成胃癌根治术.分析比较两组患者术前是否合并心肺疾病、病理类型及术后并发症等.结果 老年组术前存在其他系统疾病者明显高于对照组(68.91%比31.63%,P＜0.01).术后两组并发症的发生率相似,老年组为28.19%(75/267),对照组为25.59%(87/340).但在心肺疾病,尤其是肺部感染的发生率老年组高于对照组(17.23%比5.29%,P＜0.01).老年组淋巴结清扫范围与消化道并发症发生率的关系密切,清扫范围越小,发生率越低.结论 老年胃癌患者术后并发症的发生率主要与手术方式相关.对于术前存在手术风险的老年患者,适当减小手术范围能在根治肿瘤的前提下,减少术后并发症和手术风险.

Evaluation of surgical risk for elderly patients with gastric cancer

Objective To evaluate the clinical characteristics and surgical risks for elderly patients with gastric cancer. Methods The clinical data from 607 patients, who received surgical therapy for gastric cancer between January 2006 and December 2009, were retrospectively analyzed.Among them, 267 patients were over 65 years of age, and the other 340 patients (≤65 years of age)were served as control. Complete surgical resection was done by doctors in same group. The preoperative complications such as cardiopulmonary disease and post-operative complications as well as pathologic patterns were compared between two groups. Results Coexisted diseases were found more in elderly patients than in controls (68.91% vs 31.63 %, P＜0.01). Whereas there was no significant difference between two groups with respect to post-operative complication [28. 19% (75/267)vs 25.59 % (87/340)]. However, the incidence of cardiopulmonary complications, especially pulmonary infection, was higher in elderly patients than in controls (17.23% vs 5.29% ,P＜0.01). The digestive tract complications were related to the pattern of radical operation. Post-operative complication occurred less in patients treated with D1 radical operation than those with D2 and D3 radical operation.Conclusions The incidence of post-operative complication in elderly patients with gastric cancer was closely related to the surgical method. The elderly patients may has less complications if they were operated with D1 radical method which can reduce risk of complication and improve the quality of life.