目的 探讨高龄胃癌患者的临床特点、手术方式及围手术期处理.方法 回顾性分析年龄≥70岁的52例胃癌患者手术治疗的临床资料.结果 根治性切除38例(73.1%),减瘤术5例(9.6%),姑息手术9例(17.3%),其中姑息性切除3例(5.8%),胃空肠吻合(短路术)和空肠造瘘术共6例(11.5%).以Roux-en-Y吻合30例(57.7%),毕Ⅰ式吻合8例(15.4%),毕Ⅱ式加Brouth吻合5例(9.6%),食管胃端侧吻合6例(11.5%),食管胃端端吻合3例(5.8%).目前Roux-en-Y吻合已成为消化道重建主要方式;并发病有高血压、冠心病、慢性支气管炎、糖尿病等慢性病41例(78.8%),术后并发病加重致各种并发症29例(55.8%),其中术后因并存病加重致死亡1例;5年生存率:根治性切除为20.6%,减瘤术为0,姑息手术2.6%,其中姑息性切除2.6%,胃空肠吻合(短路术)、空肠造瘘术均为0.结论 老年胃癌患者合并病多,术后并发症重,合适的手术方案和围手术期处理是提高老年胃癌患者生存率的关键.%Objective To study the clinical characteristics and operative approaches for elderly patients with gastric cancer and the management in perioperative period. Methods The clinical data of 52 cases of gastric cancer over 70 years old treated with operation were retrospectively analyzed. Results Radical resection had been carried out in 38 cases ( 73.1％ ), tumor reducing surgery in 5 cases ( 9.6％ ) and palliative operation in 9cases ( 17.3 ％ ) including palliative resection in 3 cases ( 5.8％ ) and gastrojejunostomy in 6 cases ( 11.5％ ). Roux - en - Y anastomosis, Billroth type Ⅰ anastomosis, Billroth type Ⅱ and Brouth anastomosis, end - to - side esophagogastrostomy and end - to - end esophagogastrostomy had been performed in 30 cases ( 57.7％ ), 8 cases ( 15.4％ ), 5 cases ( 9.6％ ), 6 cases ( 11.5％ ) and 3 cases ( 5.8％ ) respectively.At the present time, Roux - en - Y anastomosis has become a main method to rebuild digestive tract. Forty one cases ( 78.8％ ) complicated with hypertension, coronary artery diseases, chronic bronchitis, diabetes mellitus etc. The various complications were worsened in 29 patients ( 55.8％ ) after operation including 1 case died of severe complications. The 5 -year survival rates were 20.6％ in patients with radical resection and 2.6％ with palliative operation including palliative resection in 2.6％ and no one survived after gastrojejunostomy and jejunostomy. Conclusion Elderly patients with gastric cancer have more complications, the postoperative complications are more heavy, and appropriate operative approaches and perioperative management are the keys of raising the survival rate of elderly patients with gastric cancer.
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