128例老年胃癌患者手术风险因素分析

摘要

Objective To evaluate the clinical characteristics and surgical risks for elderly patients with gastric cancer in order to introduce some treatment experience for the elderly gastric carcinoma patients. Methods The clinical data from 290 patients, who received surgical therapy for gastric cancer between January 2009 and December 2011, were retrospectively analyzed. Among them, 128 patients were over 65 years of age and the other 162 patients were served as controls. The preoperative complications and postoperative complications as well as age were compared between the two groups. Results The incidence of preoperative complications was relatively higher in the elderly gastric carcinoma patients as compared with normal group (71.1% vs. 27.8%). Whereas there was no significant difference between two groups in the postoperative complications. Clinically, the preoperative complications, operation time and combined organ resection were significantly correlated with the incidence of postoperative complications. In the elderly gastric carcinoma patients, the proportions of well-differentiated and moderately differentiated adenocarcinoma were higher. As for clinical stage, most patients in two groups were in stage Ⅲ and Ⅳ Conclusions The age is not a single factor so far as postoperative complications, and morbidity is concerned. The preoperative complications and surgical methods are the risk factors associated with postoperative complications. More precautions are required for elderly patients with preoperative complications in perioperative period. We should emphasize on perioperative management to reduce the incidence of postoperative complications and operative risks.%目的 分析老年胃癌患者的临床特点和手术风险,以期对老年胃癌患者的围手术期治疗提供一定的参考.方法 回顾性分析上海复旦大学附属华东医院2009年1月～2011年12月290例胃癌手术患者的临床资料,其中老年组128例,对照组162例.分析比较老年组胃癌患者的年龄、术前各种合并症与术后并发症发生率的关系.结果 老年组患者术前合并症总发生率为71.1％,高于对照组的27.8％.术后两组并发症的发生率差异无统计学意义.在老年组临床指标中,术前合并症、手术时间及是否联合脏器切除与术后并发症发生率相关.老年组患者高、中分化腺癌所占比例较高;两组患者临床分期上均以Ⅲ、Ⅳ期为主,差异无统计学意义.结论 年龄不是影响术后并发症发生率的一个独立因素,而术前合并症和手术方式是老年胃癌患者术后并发症的高危因素.对术前存在合并症的老年患者,通过加强围手术期的处理,可减少术后并发症及手术风险.