Objective To investigate the safety and feasibility of total laparoscopic radical gastrectomy of gastric cancer in elderly patients. Methods The clinical data about 72 elderly patients ( age≥70 years) with gastric cancer who underwent gastrectomy in our hospital from March 2011 to October 2017 were retrospectively analyzed,in whom, 34 patients in group A were treated by laparoscopic surgery and 38 patients in group B were treated by open surgery. The preoperative scores of American Society of Anesthesiologists ( ASA) , postoperative stage of Tumor Node Metastasis ( TNM) , operation time, the intraoperative bleeding volume, cardiopulmonary function before and after surgery, intraoperative airway pressure, the recovery time of gastrointestinal function after operation, postoperative complications and lymph node positive rate of samples were observed and compared between two groups. Results There were no significantly differences in preoperative ASA scores, postoperative TNM stages and operation time between two groups (P>0. 05). The intraoperative cardiac functions including cardiac index and ejection fraction, pulmonary functions including arterial blood PaCO2 and pH values in group A were significantly increased,as compared with those in group B (P <0. 05). However there was no significant differences in cardiopulmonary function at 24 hours after operation between two groups (P>0. 05). The intraoperative airway pressure in group A was significantly higher than that in group B (P<0. 05). The exhaust time and hospitalization time after operation in group A were significantly shorter than those in group B (P<0. 05). The intraoperative bleeding volume and incidence rate of postoperative complications in group A were significantly lower than those in group B (P<0. 05). There were no significantly differences in the numbers of pathologic lymph nodes and lymph node positive rate between the two groups (P >0. 05). Moreover there was no significant difference in total survival rate after 15-month follow-up between group A and group B (56. 1％ vs 57. 9％,P>0. 05). Conclusion The laparoscopic radical gastrectomy of gastric cancer in elderly patients has advantages of less intraoperative bleeding volume and postoperation quick recovery of gastrointestinal function, with better safety and feasibility.%目的 评价高龄患者全腹腔镜胃癌根治术的安全性与可行性.方法 回顾分析2011年3月至2017年10月72例行胃切除术高龄(≥70岁)胃癌患者的临床资料,其中34例行腹腔镜手术(A组),38例行开放手术(B组),通过分析2组术前ASA评分、术后TNM分期、手术耗时、术中出血量、术前及术后心肺功能、术中气道压力、术后胃肠道功能恢复时间、术后并发症、标本淋巴结阳性率,比较两种手术方式的安全性.结果 2组患者术前ASA评分、术后TNM分期、手术耗时差异无统计学意义(P>0.05).患者术中心功能(心脏指数、射血分数)、肺功能(动脉血PaCO2、pH值)腹腔镜手术组较开放手术组增高(P<0.05),患者术后24 h心肺功能2组间差异无统计学意义(P>0.05).2组患者间术中气道压力差异有统计学意义(P<0.05),腹腔镜手术组明显高于开放手术组(P<0.05).腹腔镜组术后排气时间、术后住院时间显著少于开腹组(P<0.05);术中出血量、手术后并发症开腹组明显高于腹腔镜组,差异有统计学意义(P<0.05);术后病理淋巴结数目、阳性率2组间差异无统计学意义(P>0.05).平均随访15个月,腹腔镜组和开腹组患者总生存率分别是56.1％ 和57.9％(P>0.05).结论 高龄患者接受腹腔镜胃癌根治术较开放手术具有出血少、术后胃肠道功能恢复快的优势,具有良好的安全性及可行性.
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