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目的探讨超高龄胃癌患者适合的手术治疗方法。方法回顾性分析1998年4月至2009年4月间收治的23例超高龄胃癌患者手术方法和随访资料,选取本院同期同类型同期别胃癌手术患者23例进行配对对照研究。比较两组患者的手术时间、输血量、失血量及术后并发症(肺部感染、切口感染、吻合口漏、吻合口狭窄)及1、3年生存率,中位生存期。结果两组患者均无手术死亡病例,无吻合口漏、吻合口狭窄,超高龄组与对照组手术时间分别为(160.12±48.37)min,(156.67±45.22)min,P>0.05;失血量分别为(185.52±128.53)ml和(202.83±132.89)ml,P>0.05;术后并发症发生率分别为52.17%,8.70%(P<0.05);术后1年、3年生存率分别为91.30%、86.95%和34.78%、39.13%;中位生存期为26个月和24个月,平均生存时间为24.8个月和23.2个月,均P>0.05,差异无统计学意义。结论超高龄胃癌患者有其特殊性,围手术期处理至关重要,其并发症发生率显著高于对照组。但是,经过术前充分准备和术后正确处理,术后生存率不比低龄组差,因此,应给与超高龄胃癌患者合理的手术治疗。
Objective To investigate the suitable surgical treatment for patients with advanced gastric cancer. Methods Retrospective analysis of surgical methods and follow-up data of 23 patients with super-advanced gastric cancer admitted from April 1998 to April 2009 were retrospectively analyzed. Twenty-three matched patients with the same type of gastric cancer at the same period were enrolled in this study. The operation time, blood transfusion volume, blood loss and postoperative complications (lung infection, incision infection, anastomotic leakage and anastomotic stenosis) and 1, 3 year survival rate and median survival time were compared between the two groups. Results There were no operative deaths, no anastomotic leakage and anastomotic stenosis in the two groups. The operative time was (160.12 ± 48.37) min and (156.67 ± 45.22) min respectively in the super-aged group and the control group (P> 0.05) (185.52 ± 128.53) ml and (202.83 ± 132.89) ml respectively, P> 0.05; The incidences of postoperative complications were 52.17% and 8.70% respectively (P <0.05); The 1 year and 3 year survival rates were 91.30 %, 86.95% and 34.78%, 39.13% respectively. The median survival time was 26 months and 24 months. The average survival time was 24.8 months and 23.2 months, both P <0.05. The difference was not statistically significant. Conclusion The patients with ultra-advanced gastric cancer have their own particularities. Perioperative management is very important. The incidence of complications is significantly higher than that of the control group. However, after preoperative preparation and postoperative correct treatment, the postoperative survival rate is not worse than that of the younger age group, therefore, should be given reasonable surgical treatment of patients with ultra-advanced gastric cancer.