CAJ | 학술논문

目的：探讨高龄患者腹腔镜胃癌手术围手术期处理的方法及高龄患者行腹腔镜胃癌手术的安全性、可行性。方法回顾分析该院普外科2009年6月至2014年4月间收治的280例高龄（≥70岁）胃癌患者的临床资料，其中163例行腹腔镜手术（腹腔镜组），117例行开腹手术（开腹组），比较两组患者的一般资料及术中、术后相关指标。结果两组患者年龄、性别、临床病理分期、病理类型、肿瘤部位、手术方式和术前合并症等比较差异无统计学意义（P＞0．05）。与开腹组比较，腹腔镜组手术时间延长，但差异无统计学意义（P＞0．05），而腔镜组术中出血量少、术后拔胃管时间、下床活动时间、进食时间、通气时间、住院时间均短于开腹组，并发症发生率较开腹组降低，差异存在统计学意义（P＜0．05）。结论合理的围手术期处理是保证高龄患者腹腔镜胃癌手术成功的关键。重视术前合并症的处理，术中贯彻微创观念和使用微创外科技术，采取个体化手术方式，积极防治术后并发症，腹腔镜胃癌手术在高龄患者中的应用是安全可行的，且相对于传统开腹手术优势明显。
목적：탐토고령환자복강경위암수술위수술기처리적방법급고령환자행복강경위암수술적안전성、가행성。방법회고분석해원보외과2009년6월지2014년4월간수치적280례고령（≥70세）위암환자적림상자료，기중163례행복강경수술（복강경조），117례행개복수술（개복조），비교량조환자적일반자료급술중、술후상관지표。결과량조환자년령、성별、림상병리분기、병리류형、종류부위、수술방식화술전합병증등비교차이무통계학의의（P＞0．05）。여개복조비교，복강경조수술시간연장，단차이무통계학의의（P＞0．05），이강경조술중출혈량소、술후발위관시간、하상활동시간、진식시간、통기시간、주원시간균단우개복조，병발증발생솔교개복조강저，차이존재통계학의의（P＜0．05）。결론합리적위수술기처리시보증고령환자복강경위암수술성공적관건。중시술전합병증적처리，술중관철미창관념화사용미창외과기술，채취개체화수술방식，적겁방치술후병발증，복강경위암수술재고령환자중적응용시안전가행적，차상대우전통개복수술우세명현。
Objective To explore perioperative management for elderly patients undergoing laparoscopic gastric surgery and safety and feasibility of laparoscopic gastric surgery for elderly patients .Methods The clinical data of 280 elderly patients(≥70 years) with gas-tric cancer undergoing gastrectomy from June 2009 to April 2014 were retrospectively analyzed .Of the patients ,163 cases underwent laparoscopic gastrectomy ( laparoscopic group ) and the other 117 cases underwent traditional open gastrectomy ( open surgery group ) . The general data ,intraoperative and postoperative variables of the two groups were compared .Results There were no significant differ-ences between the two groups in age ,sex distribution,clinical and pathological staging ,pathological type ,tumor location,mode of opera-tion and preoperative complications (P>0.05).The average operative time was longer in laparoscopic group compared with open sur -gery group,but there were no significant differences (P>0.05).The average intraoperative blood loss ,pull tube time,postoperative am-bulation time,feeding time,ventilation time,average length of hospital stay and incidence of postoperative cardiopulmonary complica -tions were all significantly reduced in laparoscopic group compared with open surgery group .There were significant differences ( P<0.05).Conclusions Reasonable perioperative management is critical to ensure the success of laparoscopic gastric surgery for elderly patients.As long as emphasis is made on treatment of preoperative complications ,use of minimally invasive surgical techniques ,take in-dividual operation mode ,and prevention of postoperative complications in elderly patients with gastric cancer ,laparoscopic gastric sur-gery is safe and feasible for elderly patients and has obvious advantages compared with traditional open gastrectomy .