65岁以上老年人胃癌332例临床分析

目的 探讨老年胃癌患者的临床特点及其外科治疗方法的选择及预后。方法 回顾性分析1990年1月至2003年6月收治的332例65岁以上老年人胃癌的临床资料和生存资料。结果 本组临床好转率为97．0％，围手术期病死率为3．0％，手术并发症发生率为24．7％。根治性胃切除组术后1、3、5年生存率分别为89.6％、63.2％和40.6％，姑息性胃切除组分别为68.6％、15．7％和0，未切除组平均生存10个月。各组术后生存率比较差异有显著性(P＜0．05)。结论 老年人胃癌术后并发症较多，围手术期处理至关重要。术中应尽量采用硬膜外麻醉，缩短手术时间。手术方式应视患者全身情况、癌肿所在部位、大小及侵犯范围而定，对早中期患者力争行根治性胃切除术(D1或D2)。

Clinical study of gastric cancer in patients aged 65 years and older

Objective To investigate clinical characteristics,surgical treatment methods,and prognosis of elderly patients with gastric cancer. Methods Clinicopathological and periodical follow-up data of 332 patients aged 65 years and older with gastric cancer from January 1990 to June 2003 were studied retrospectively. Results The clinical cure rate was 97.0%,the fatality in the peri-operative period was 3.0%,and the postoperative complication rate was 24.7%. The 1-,3- and 5- year survival rates were 89.6%,63.2% and 40.6% in radical gastrectomy group and 68.6%,15.7% and 0 in palliative gastrectomy group respectively.The average survival period was ten months in no-resection group. The survival rate in radical gastrectomy group was significantly higher than that in palliative gastrectomy group( P <0.05). Conclusions The postoperative complication rate was high in elderly patients with gastric cancer. The management during peri-operative period is very important. The peridural anaesthesia should be positively performed ,and the operative time should be shorten as far as possible. The choice of operative methods should be determined according to general condition of the patients,and position ,size,and range of tumour. The operative procedure for early and middle stages of gastric cancer is radical gastrectomy (D 1 or D 2 ). Hyperthermic intraoperative intraperitoneal chemotherapy may improve curative effect of the patients.