37 例老年胃癌合并胰腺受侵围手术期的临床治疗分析

目的:探讨老年胃癌合并胰腺受侵患者围手术期合并症及并发症发生率与其他老年胃癌患者间的差异,优化老年胃癌合并胰腺受侵患者围手术期临床治疗护理策略。方法:收集2005年2月至2009年10月前来我院治疗的37名年龄>65岁的老年胃癌合并胰腺受侵患者作为研究对象,设置相同年龄胃癌无胰腺受侵患者37例作为对照,收集详细临床资料,对两组间围手术期合并症发生情况进行卡方(x2)检验,通过采取不同临床治疗护理手段进一步施行干预(包括不同的手术方式及临床监测管理模式),再次采用x2检验比较两组术后并发症发生率,最后通过随访实现Kaplan-Meier生存分析。结果:老年胃癌合并胰腺受侵组(组Ⅰ)与老年胃癌无胰腺受侵组(组Ⅱ)术前总体合并症发生率并无显著统计学差异(P>0.05);各项合并症中仅有血红蛋白降低(<100g/L)、白蛋白降低(<35g/L)以及合并糖尿病的患病人数存有统计学意义(P=0.020,P=0.032,P=0.013);根据两组患病情况不同采取不同手术方式,两组死亡人数未见统计学意义(P>0.05);组Ⅰ术后并发症发生率为70.27%,低于组Ⅱ的86.49%,但两组未见明显统计学差异(P>0.05);比较两组功能性、心血管类并发症,两者间存在显著统计学差异(P=0.036,P=0.013);两组术后5年生存率比较无统计学差异(P=0.8308)。结论:需加强对老年晚期胃癌合并胰腺患者围手术期的临床治疗护理策略,采取适宜的手术治疗方式,可减少术后并发症及死亡的发生,提高患者生活质量。

Surgical Treatment Analysis of 37 Cases of Gastric Cancer Invadingthe Pancreas

Objective: To discuss the difference of perioperative complications incidence between elderly patients with gastric cancer invading the pancreas and elderly patients with gastric cancer without invading.Optimize the perioperative clinical therapy and nursing strategy for these cases.Methods: We collected 37 volunteers who accepted the therapy for gastric cancer invading the pancreas aged more than 65 years old in this hospital from February,2005 to October,2009.Another 37 elderly patients of gastric cancer with no invading the pancreas in same ages were taken as the control.Detailed clinical information of all cases were collected.These two groups of perioperative complications incidence were analyzed by chi-square test(x2),adopting different clinical treatment and nursing strategy given further intervention(including different surgical methods,and clinical monitoring management mode).At last,the incidence of postoperative complications between the two groups were compared by chi-square test(x2) and follow-up realize Kaplan-Meier survival analysis.Results: There was no significant difference between the incidence of total complications in Group I and this in Group II(P>0.05).But the incidence of Hemoglobin reducing(<100g/L),Albumin reducing(<35g/L) and diabetes was significance between two groups(P=0.020,P= 0.032,P=0.013).The mortality in two groups had no statistical significance(P >0.05).The incidence of postoperative com-plications(70.27%) of Group I was lower than Group II(86.49%),there was no significant difference between two groups.The incident of functional or cardiovascular postoperative complications in two groups were different(P=0.036,P=0.013),the proportion for postoper-ative 5 years survival in two groups were not distinguishing(P=0.8308).Conclusion: It is necessary to strengthen the perioperative clini-cal treatment,monitor strategies for the elderly with gastric cancer invading the pancreas and adopt proper surgical method,which could reduce the incidence and mortality of postoperative complications and improve the quality of life for patients.