CAJ | 학술논문

目的：探讨腹腔镜辅助胃癌根治术应用于高龄患者的临床疗效。方法回顾性分析北京大学肿瘤医院胃肠肿瘤微创外科在2009年5月至2012年12月间行腹腔镜辅助胃癌根治术的214例患者的临床资料，其中年龄大于或等于70岁者53例（高龄组），小于70岁者161例（非高龄组），比较两组患者的手术情况及术后恢复。结果高龄组总体ASA评分比非高龄组差，且合并高血压和糖尿病的患者更多（均P＜0．05）。两组平均手术时间、术中失血量、术中输血率、中转开腹率、术后排气时间和术后住院时间比较，差异均无统计学意义（均P＞0．05）。高龄组清扫淋巴结数目与非高龄组相比有减少趋势，分别为（26．4±9．7）枚和（30．0±12．4）枚，但两组比较，差异无统计学意义（P＞0．05）。高龄组和非高龄组患者术后总体并发症发生率分别为30．2％（16／53）和19．9％（32／161），手术相关并发症发生率分别为18．9％（10／53）和18．0％（29／161），差异均无统计学意义（均P＞0．05）；但高龄组术后内科系统并发症发生率更高[11．3％（6／53）比1．9％（3／161），P＜0．05]。两组术后30 d内死亡率分别为1．9％（1／53）和0．6％（1／161），差异无统计学意义（P＞0．05）。结论高龄患者由于合并更多基础疾病，增加了术后内科并发症的风险，但腹腔镜辅助胃癌根治术并不增加高龄患者的手术相关风险。
목적：탐토복강경보조위암근치술응용우고령환자적림상료효。방법회고성분석북경대학종류의원위장종류미창외과재2009년5월지2012년12월간행복강경보조위암근치술적214례환자적림상자료，기중년령대우혹등우70세자53례（고령조），소우70세자161례（비고령조），비교량조환자적수술정황급술후회복。결과고령조총체ASA평분비비고령조차，차합병고혈압화당뇨병적환자경다（균P＜0．05）。량조평균수술시간、술중실혈량、술중수혈솔、중전개복솔、술후배기시간화술후주원시간비교，차이균무통계학의의（균P＞0．05）。고령조청소림파결수목여비고령조상비유감소추세，분별위（26．4±9．7）매화（30．0±12．4）매，단량조비교，차이무통계학의의（P＞0．05）。고령조화비고령조환자술후총체병발증발생솔분별위30．2％（16／53）화19．9％（32／161），수술상관병발증발생솔분별위18．9％（10／53）화18．0％（29／161），차이균무통계학의의（균P＞0．05）；단고령조술후내과계통병발증발생솔경고[11．3％（6／53）비1．9％（3／161），P＜0．05]。량조술후30 d내사망솔분별위1．9％（1／53）화0．6％（1／161），차이무통계학의의（P＞0．05）。결론고령환자유우합병경다기출질병，증가료술후내과병발증적풍험，단복강경보조위암근치술병불증가고령환자적수술상관풍험。
Objective To investigate the clinical efficacy of laparoscopy-assisted radical gastrectomy in elderly patients with gastric cancer. Methods Clinical data of 214 patients with gastric cancer were analyzed retrospectively, who underwent laparoscopy-assisted radical gastrectomy in the Department of Minimally Invasive Gastrointestinal Surgery at Beijing Cancer Hospital between May 2009 and December 2012. The patients were divided into two groups, consisting of elderly group (age ≥70 years old, n=53) and non-elderly group (age < 70 years old, n=161). The operative procedure and postoperative recovery were compared between the two groups. Results Elderly group had a worse ASA score as compared to non-elderly group with significant difference (P<0.05). Among the elderly, the incidences of concomitant diseases, such as hypertension and diabetes, were significantly higher. No significant differences were observed in terms of duration of operation, blood loss, blood transfusion rate, conversion to laparotomy, time to first flatus and postoperative hospital stay between the two groups (P>0.05). The mean number of retrieved lymph nodes in elderly group was less than that of non-elderly group (26.4±9.7 vs. 30.0±12.4), but whose difference was not significant (P>0.05). There were no significant differences between two groups with respect to postoperative complications (30.2% vs. 19.9%, P>0.05) and surgery-related complications (18.9% vs. 18.0%, P>0.05), but the incidence of medical complications was higher in elderly group (11.3% vs. 1.9%, P<0.05). Furthermore, the perioperative mortality was 1.9% and 0.6% respectively in elderly and non-elderly groups without significant difference (P>0.05). Conclusion Associated with more concomitant diseases, the elderly had higher risk of medical complications after operation , while laparoscopy-assisted radical gastrectomy does not increase the risk of surgery-related complications in elderly patients.