老年胃癌患者的手术治疗

目的 探讨老年胃癌患者的临床特点和外科手术治疗.方法 回顾性分析上海交通大学医学院附属瑞金医院普外科1984-1998年间70岁以上的431例老年胃癌患者的临床资料和手术疗效.结果 临床表现以上腹胀痛不适为主,另有食欲不振和体重减轻,Ⅲ、Ⅳ期患者占64.2%,病理无明显特殊性.431例老年胃癌患者中,行根治性切除215例(49.9%),姑息性切除122例(28.3%),手术总病死率为5.1%,术后并发症发病率为25.5%.术后5年生存率为29.5%,其中根治性切除5年生存率为53.2%,姑息性切除为10.7%,两者生存率比较有显著性差异(P<0.01).结论 老年胃癌患者晚期居多,术后并发症发病率高.早期诊断,加强围手术期处理以及行合理的根治性切除手术,是提高老年胃癌患者生存率和生活质量的关键.

Surgical treatment of gastric cancer in the elderly

Objective To explore the clinical characteristics and surgical treatment of gastric cancer in elderly patients.Methods The clinical data of 431 patients older than 70 years with gastric cancer from 1984 to 1998 were analyzed retrospectively.Results The main clinical manifestations were upper abdominal pain,distension or upset,loss of appetite and weight.The patients with clinicalⅢ,Ⅳ stage accounted for 64.2 percent.Pathological findings showed no specificity.Radical gastrectomy was performed in 215 cases(49.9%),and palliative resection was done in 122 ones(28.3%).The operative mortality and postoperative complication rate were 5.1%and 25.5%in the patients respectively.The 5-year survival rate was 29.5%in the patients with surgery,53.2%with radical gastrectomy and 10.7%with palliative resection.There were significant differences in 5-year survival rate between the radical and palliative groups.Conclusions The majority of elderly patients are clinical Ⅲ,Ⅳ stages and their operative complication rate is high.The key to increase the survival rate and life quality of elderly patients with gastric cancer is early diagnoses,strong perioperative management and suitable radical surgery.