CAJ | 학술논문

目的探讨腹腔镜辅助胃癌根治术在老年胃癌患者中应用的可行性及临床疗效.方法 2007年1月至2009年12月期间,福建医科大学附属协和医院胃外科对255例年龄在65岁以上的老年胃癌患者施行D2根治术,其中行腹腔镜辅助胃癌根治术患者(腹腔镜组)116例,行常规开腹手术患者(开腹组)139例.比较两组患者术中、术后恢复、并发症发生及术后生存情况,并对术后并发症的危险因素进行分析.结果腹腔镜组术中出血量和术中输血例数均少于开腹组,术后排气时间、进食流质时间和住院时间均短于开腹组,差异均有统计学意义(P＜0.01)；而两组患者手术时间和淋巴结清扫数目的差异无统计学意义(均P＞0.05).腹腔镜组术后并发症发生率为15.5％(18/116),明显低于开腹组的28.1％(39/139)(P＜0.05).是否行腹腔镜手术(P＜0.05)、手术时间(P＜0.01)和术前合并症(P＜0.01)是老年人胃癌术后并发症的独立危险因素；手术时间(P＜0.05)和术前合并症(P＜0.01)是老年人腹腔镜辅助胃癌根治术后并发症的独立危险因素.腹腔镜组和开腹组患者术后平均生存时间分别为23.0和22.5个月,差异无统计学意义(P＞0.05).结论老年人腹腔镜辅助胃癌根治术能够达到与开腹手术相同的根治效果,且具有明显的微创优势.手术时间和术前合并症是老年人腹腔镜胃癌根治术后并发症的独立危险因素.
목적 탐토복강경보조위암근치술재노년위암환자중응용적가행성급림상료효.방법 2007년1월지2009년12월기간,복건의과대학부속협화의원위외과대255례년령재65세이상적노년위암환자시행D2근치술,기중행복강경보조위암근치술환자(복강경조)116례,행상규개복수술환자(개복조)139례.비교량조환자술중、술후회복、병발증발생급술후생존정황,병대술후병발증적위험인소진행분석.결과 복강경조술중출혈량화술중수혈례수균소우개복조,술후배기시간、진식류질시간화주원시간균단우개복조,차이균유통계학의의(P＜0.01)；이량조환자수술시간화림파결청소수목적차이무통계학의의(균P＞0.05).복강경조술후병발증발생솔위15.5％(18/116),명현저우개복조적28.1％(39/139)(P＜0.05).시부행복강경수술(P＜0.05)、수술시간(P＜0.01)화술전합병증(P＜0.01)시노년인위암술후병발증적독립위험인소；수술시간(P＜0.05)화술전합병증(P＜0.01)시노년인복강경보조위암근치술후병발증적독립위험인소.복강경조화개복조환자술후평균생존시간분별위23.0화22.5개월,차이무통계학의의(P＞0.05).결론 노년인복강경보조위암근치술능구체도여개복수술상동적근치효과,차구유명현적미창우세.수술시간화술전합병증시노년인복강경위암근치술후병발증적독립위험인소.
Objective To evaluate the feasibility and efficacy of laparoscopy-assisted radical gastrectomy with D2 lymph node (LN) dissection for elderly patients with gastric cancer.Methods From January 2007 to December 2009,255 gastric cancer patients aged over 65 years underwent D2 LN dissection.Of these,116 patients underwent laparoscopy-assisted radical gastrectomy (LAG group),while 139 patients underwent conventional open gastrectomy(OG group).The recovery and complication rate were compared between the two groups.Risk factors associated with postoperative complications were investigated by univariate and multivariate analyses.Results Compared to the OG group,the mean blood loss and number of patients who required blood transfusion were less,and the time to first flatus,the time to resume soft diet,and postoperative hospital stay were shorter in the LAG group(all P＜0.01).However,the operation time and the mean number of LN retrieval were not significantly different between the two groups (both P＞0.05).The postoperative morbidity in the LAG group was 15.5％(18/116),lower than that in OG group [28.1％(39/139),P＜0.05].Logistic regression analysis revealed that there were three significant factors associated with postoperative complications such as laparoscopy-assisted gastrectomy (P＜0.05),operation time (P＜0.01),and preoperative comorbidity (P＜0.01).Operation time (P＜0.05) and preoperative comorbidity (P＜0.01) were independent risk factors for complication in laparoscopy-assisted radical gastrectomy of elderly patients.The mean survival time of LAG and OG were 23.0 months and 22.5 months,respectively,and the difference was not statistically significant(P＞0.05).Conclusions Laparoscopy-assisted radical gastrectomy with D2 LN dissection is oncologically compatible with open gastrectomy in elderly patients with gastric cancer less invasive.Operation time and preoperative comorbidity are independent risk factors for complication in laparoscopy-assisted radical gastrectomy of elderly patients.