高龄老年胃癌的外科治疗  

Surgical Treatment for Gastric Carcinoma in Elderly Patients

作　　者：薛建元[1] 尹浩然[1] 朱正纲[1] 李树发[1] 燕敏[1] 林言箴[1] 

机构地区：[1]上海第二医科大学附属瑞金医院外科上海消化外科研究所,上海市200025

出　　处：《中国肿瘤临床》2000年第5期352-355,共4页Chinese Journal of Clinical Oncology

摘　　要：目的 :面对日益增多的高龄老年胃癌 ,探讨适当的外科手术治疗。方法 :回顾性分析我院普外科 1984～1993年间 2 12例 70岁以上高龄老年胃癌的临床资料及手术疗效。结果 :高龄老年胃癌起病隐匿 ,常伴有出血、梗阻及贫血 ;绝大多数合并有其他疾病。手术证实绝大多数为中晚期胃癌 ,病理检查无明显特殊性。 16 3例行胃癌切除术 ,切除率为 76 9% ;其中根治性切除 10 3例 (6 3 2 % )。切除术死亡率 3 1%。手术并发症发生率 13 2 %。切除术后 5年生存率为 37 9% ,根治性切除达 5 9 3%。姑息性切除平均生存期 11 8个月。临床早期胃癌 (Ⅰa、Ⅰb期 )切除术后 5年生存率达 92 5 % ,中期胃癌 (Ⅱ、Ⅲa期 )为 43 2 % ,晚期 (Ⅲb、Ⅳ期 )仅 2 9%。结论 :近年高龄老年胃癌逐渐增多 ,应争取早期诊断 ,及时治疗。经术前充分准备 ,术后积极处理 ,老年人多能耐受手术。对早期和中期胃癌 ,力争行根治性切除术 (D2 ) ,可以获得较满意的长期疗效。Objective: To probe the suitable surgical treatment of gastric cancer along with the increase of gastric cancer in old people Methods: The clinical data and operative effects were analysed retrospectively in 212 patients with gastric cancer aged over 70 years in the period of 1984 to 1993 Results: The gastric cancer in elderly had an occult occurrence and frequently accompanied by bleeding, obstruction and anemia Most of the old patients had other diseases Operation verified that most of them were advanced cancers Pathological findings showed no specificity Gastrectomy was performed in 163 cases with a resection rate of 76 9%, among them 103 cases (63 2%) underwent radical gastrectomy The operative mortality for gastrectomy was 3 1%and the postoperative complication rate was 13 2% The 5-year survival rate for gastrectomy was 37 9%and it was 59 3%for radical resection The mean survival time for palliative resection was 11 8 months The 5-year survival rate for the clinically early gastric cancer (Ⅰa,Ⅰb) was 92 5%, the middle stage (Ⅱ, Ⅲa) 43 2%, but the late stage cancer (Ⅲb,Ⅳ) was only 2 9% Conclusion: The gastric cancer in elderly is increasing in recent years and should be diagnosed earlier The old patients can tolerate operation by optimal preparation and careful treatment For early and middle stage gastric cancer radical gastrectomy and lymphadenectomy (D 2) may achieve fine long-term outcome

关 键 词：胃癌 老年人 外科手术 D2术 术式 疗效 

分 类 号：R735.2[医药卫生—肿瘤]