摘要
目的探讨高龄胃癌手术患者的临床病理特点、手术效果、并发症影响因素和预后。方法回顾性分析手术治疗的80岁以上的高龄胃癌患者84例的临床资料。结果I期10例(Ia期8例,Ib期2例),II期12例,Ⅲ期45例(53.6%),IV期17例。81%的患者存在一种或一种以上的合并症,主要为心血管疾病(43例,51.2%)。肿瘤切除率为85.7%(72/84),根治性切除率为60.7%(51/84)。51例根治性手术中,27例患者实施了D0/D1手术(52.9%),24例实施了D2手术(47.1%)。总的术后并发症为28.6%,手术相关并发症为6.0%;肺炎为最常见的非手术相关并发症(14.3%)。术后病死率为3.6%。肿瘤体积大小是影响术后并发症的独立危险因素(P=0.009)。根治性手术的总5年生存率为56.9%,其中D1手术的5年生存率为63.0%,D2手术的5年生存率为50.0%。I期胃癌5年生存率为80.0%。结论对有轻微合并症的高龄胃癌患者(>80岁)行范围较小的淋巴结廓清手术是安全有效的,并可获得良好的预后。
Objective To analyze the clinicopathologic features, effect of surgical treatment and prognosis of elderly patients with gastric cancer. Methods The records of 84 elderly patients （ aged 80 years or above ） with gastric cancer who underwent operation in our hospital from 2000 -2008 were analyzed retrospectively. Results Ten patients had early gastric cancer （ Ⅰ a, 8 cases, Ⅰ b, 2cases ） , stage Ⅱ 12 cases, stage Ⅲ 45 cases （53. 6% ） and stage Ⅳ 17 cases. Among them, 81% patients had one or more co-morbidities. Cardiovascular disease was present in 43 cases （51.2% ）. Resection rate was 85.7 % （72/84）. Radical resection rate was 60.7% （51/84）. Limited nodal dissection（ 〈 D2 ） was done in 27 cases （52.9%）. D2 dissection was performed in 20 cases （47. 1% ）. The postoperative complication rate was 28.6% , and the rate of surgical related morbidities was 6.0 % . The main non-surgical complication in postoperative period was pulmonary infection （14. 3% ）. The tumor size was an independent risk factor for postoperative complications （ P = 0. 009 ）. Postoperative mortality was 3. 6 % （ n = 3 ）. The 5 years smvival rate was 63.0% for limited nodal dissection and 50.0% for D2 dissection. Total survival rate for radical resection was 56.9%. The 5-year survival rate for stage Ⅰ cancer was 80. 0%. Conclusions Gastrectomy with limited nodal dissection in elderly patients with gastric cancer and mild preoperative co-morbidity is safe and effective,and can achieve a good prognosis.
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2010年第4期386-391,共6页
China Journal of General Surgery
