老年人早期胃癌的外科治疗

目的探讨老年人早期胃癌的特点及外科治疗适宜手术方式及预后.方法回顾性分析1977年8月～1997年12月平均年龄为68岁的74例早期胃癌患者共施行78次手术,术后通过临床和胃镜随诊,随诊率为100%.用SAS软件对早期胃癌术后生存概率分析. 结果本组手术切除率100%,手术死亡率0,腹腔及切口感染0,无吻合口漏.5年生存率98.59%±0.14%(95%可信区间);10年生存率91.61%±0.04%(95%可信区间).淋巴结转移率5.4%.本组早期胃癌无淋巴结转移者5年生存率为100%.4例有淋巴结转移或淋巴管癌栓,5年生存率为75%.结论纤维胃镜普查使老年人早期胃癌发现率增加,年龄不是早期胃癌根治切除的禁忌证,由于早期胃癌多癌灶病例占18.92%,即使病变较小,亦应作3/4胃切除,癌灶相距远者应行全胃切除.本组胃癌诊断早,手术根治及时,选择术式适当.本组5、10年生存率高,且术后生活质量优良.

Surgical treatment of elderly patients with early gastric cancer

OBJECTIVE: To investigate the characteristics of early gastric cancer (EGC), surgical treatment, and prognosis in elderly patients. METHODS: Seventy-four patients with EGC with a mean age of 68 years treated by gastrectomy from August 1977 to December 1997 were studied retrospectively. A total of 74 patients were followed up, and the SAS statistical package program was used for all analyses. RESULTS: The cumulative 5-year survival rate was 98.59% +/- 0.14%, and the 10-year survival rate was 91.61% +/- 0.04%. The 5-year survival rate in patients without lymph node metastasis was 100% and node-positive was only 75%. All of 74 patients were respectable, and there was neither operative death nor surgical infection. CONCLUSIONS: If general condition in elderly patients permits, radical gastrectomy should be the choice of treatment for EGC, and D2 lymphadenectomy would be beneficial to some node positive patients. Local gastrectomy and partial gastrectomy are not suitable for EGC because of EGC may have multiple foci of cancer in 18.92%.