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目的探讨腹腔镜在老年胃癌患者根治术中应用的安全性及可行性。方法回顾性分析广东省人民医院胃肠外科2010年1月至2014年9月期间收治的146例行根治性手术治疗的老年(年龄≥65岁)胃癌患者的临床资料,对比分析腹腔镜与开腹手术的术中和术后情况以及术后并发症的差异。结果 (1)行腹腔镜手术者40例(腔镜组),行开腹手术者106例(开腹组),2组患者的年龄、性别、体质量指数、术前白蛋白、美国麻醉医师协会分级、肿瘤部位、分化程度、病理分期、胃切除方式及吻合方式比较差异均无统计学意义(P>0.05)。(2)2组均无术中死亡病例。腔镜组术中清扫的淋巴结数与开腹组比较差异无统计学意义(P>0.05)。腔镜组的术中出血量、术后首次排气时间、术后首次进食时间及术后住院时间均明显少于或短于开腹组(P<0.05),只是腔镜组的手术时间要长于开腹组(P<0.05)。(3)腔镜组术后有4例(10.0%)发生并发症,开腹组术后有16例(15.1%)发生并发症,2组总并发症发生率比较差异无统计学意义(χ~2=0.64,P=0.591)。2组患者术后并发症Clavien-Dindo分级情况比较差异无统计学意义(χ~2=0.63,P=0.592)。(4)腔镜组术后无死亡病例,开腹组术后有1例死亡病例,死因为肺栓塞导致的呼吸循环衰竭。结论从本研究有限的病例研究数据来看,腹腔镜辅助胃癌根治术对于老年胃癌患者能减少术中出血量、缩短术后排气、进食及住院时间,可获得与开腹手术同样的根治效果,且不增加术后并发症,是安全、可行的。
Objective To investigate the safety and feasibility of laparoscopy in the treatment of elderly patients with gastric cancer. Methods The clinical data of 146 elderly patients (aged ≥ 65 years) with gastric cancer who underwent radical surgery between January 2010 and September 2014 in Guangdong Provincial People’s Hospital for gastrointestinal surgery were analyzed retrospectively. The correlation between laparoscopy and open Intraoperative and postoperative abdominal surgery and postoperative complications. Results (1) 40 cases of laparoscopic surgery (endoscopic group), 106 cases of open laparotomy (open group), two groups of patients age, gender, body mass index, preoperative albumin, the United States anesthesiologist There was no significant difference in classification, tumor location, differentiation, pathological staging, gastrectomy and anastomosis between the two groups (P> 0.05). (2) There were no intraoperative deaths in both groups. There was no significant difference in the numbers of lymph nodes dissected between endoscopic group and open group (P> 0.05). The mean intraoperative blood loss, the first postoperative exhaust time, the first postoperative meal time and postoperative hospital stay were significantly shorter or shorter than those in the open group (P <0.05), but the operative time of the endoscopic group Longer than the open group (P <0.05). (3) Complications occurred in 4 cases (10.0%) after laparoscopic surgery and in 16 cases (15.1%) after laparotomy. There was no significant difference in the total complication rates between the two groups (χ ~ 2 = 0.64, P = 0.591). There was no significant difference in Clavien-Dindo grade between two groups (χ ~ 2 = 0.63, P = 0.592). (4) There was no death after surgery in the endoscopic group, and one death was found in the laparotomy group. The cause of death was respiratory failure due to pulmonary embolism. Conclusions From the limited case study data in this study, laparoscopic-assisted radical gastrectomy for gastric cancer patients can reduce the amount of intraoperative bleeding, shorten the postoperative exhaust, feeding and hospitalization, can be obtained with the same radical effect of laparotomy , And does not increase postoperative complications, is safe and feasible.