目的 探讨老年贲门癌手术治疗经胸及经腹入路的优缺点及选择原则.方法 回顾性分析78例年龄大于65岁老年贲门癌患者行经胸及经腹径路手术治疗的临床资料.结果 经胸组和经腹组的上切缘阳性率分别为4.08%和13.79%,平均淋巴结清除个数分别为9.8和13.2个,两组间比较差异有统计学意义(P<0.05);下切缘阳性率、上下切缘阳性率、并发症发生率、手术根治率、手术后平均恢复时间以及平均生存时间,分别为4.08%和6.89%,2.04%和6.89%,12.24%和10.34%,86.20%和87.75%,11d和9d,(3.5±1.2)和(3.0±2.3)年,两组间比较差异均无统计学意义(P>0.05).结论 应个体化选择老年贲门癌患者手术径路,充分考虑老年患者的病变部位、范围、分期以及呼吸、心血管系统状况.%Objective To explore the advantages and disadvantages of surgical treatment of elderly patients with cardiac carcinoma by thoracic and abdominal approach and its selection principle.Methods The clinical data of 78 patients over the age of 65 years with cardiac carcinoma who underwent surgical treatment by thoracic and abdominal approach were retrospectively analyzed.Results The positive rate of the upper incisal margin in the thoracic and abdominal group was respectively 4.08% and 13.79%,while the mean clearance number of lymph nodes was respectively 9.8 and 13.2,and the difference between the two groups was statistically significant(P<0.05).The positive rate of the lower incisal margin,positive rate of the upper and lower incisal margin,complication rate,surgical cure rate,the average recovery time and the average survival time after surgery were respectively 4.08% and 6.89%,2.04% and 6.89%,12.24% and 10.34%,86.20% and 87.75%,11 and 9 days,(3.5±1.2)and(3.0±2.3)years,and the differences between the two groups were not statistically significant(P>0.05).Conclusion The choice of surgical approach for the elderly patients with gastric cardia cancer should be individualized,taking into account the location,range,staging,respiratory and cardiovascular status of the elderly patients.
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