老年人早期胃癌的外科治疗  

Surgical treatment of elderly patients with early gastric cancer

作　　者：顾倬云[1] 

机构地区：[1]解放军总医院南楼普外科,北京100853

出　　处：《中华外科杂志》2001年第12期901-903,共3页Chinese Journal of Surgery

摘　　要：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 6 8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 10 0 %。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 10 0 %,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 5 9%± 0 14%(95 %可信区间 ) ;10年生存率 91 6 1%± 0 0 4%(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 10 0 %。 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。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 D 2 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%.

关 键 词：老年人 胃肿瘤 外科手术 术式 生活质量 生存率 

分 类 号：R735.2[医药卫生—肿瘤] R730.56[医药卫生—临床医学]