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目的分析高龄食管胃交界腺癌(EGJAC)患者临床病例特征和手术治疗的可行性。方法选取139例EGJAC患者,其中70岁及以上62例为高龄组,70岁以下77例为对照组。对两组的性别分布、平均病程、临床表现、Siewert分型、组织学分型、临床分期、手术切除率等进行比较。结果高龄组男女比例(1.70︰1)与对照组男女比例(1.48︰1)比较差异无统计学意义(P﹥0.05);高龄组患者平均病程(8.43±2.85)月,明显高于对照组(4.78±1.23)月(P﹤0.05);高龄组食欲减退及体重下降症状明显高于对照组,吞咽困难及剑突后疼痛症状明显少于对照组(P﹤0.05);两组最常见的分型均是SiewertⅡ型,临床分期最常见均为Ⅲ期;高龄组高分化腺癌比例明显高于对照组,低分化腺癌比例低于对照组(P﹤0.05);高龄组患者手术切除率(87.10%)与对照组(81.82%)比较差异无统计学意义(P﹥0.05)。结论高龄EGJAC患者病程较长、临床症状更加不典型,但以分化较好的中、高分化腺癌为主,手术切除率仍较高,因此对高龄患者应适当放宽内镜检查及活检的适应症,高龄不是手术的绝对禁忌症。
Objective To analyze the clinical characteristics of patients with esophageal and gastric adenocarcinoma (EGJAC) and the feasibility of surgical treatment. Methods A total of 139 patients with EGJAC were selected, of which 62 were 70 years old and above, and 77 cases under 70 years old as control group. The gender distribution, average course of disease, clinical manifestations, Siewert classification, histological classification, clinical stage and surgical resection rate were compared between the two groups. Results There was no significant difference between male and female ratio (1.70︰1) in the advanced age group and male to female ratio (1.48︰1) in the control group (P> 0.05). The average duration of the elderly patients was (8.43 ± 2.85) months, which was significantly higher than that in the control group 4.78 ± 1.23) months (P <0.05). The symptoms of loss of appetite and weight loss in the advanced age group were significantly higher than those in the control group. The symptoms of dysphagia and xiphoid pain were significantly less than those in the control group (P <0.05) (P <0.05). The rates of surgical resection in the advanced age group (P <0.05) were significantly higher than those in the control group (P <0.05) 87.10%) compared with the control group (81.82%) showed no significant difference (P> 0.05). CONCLUSIONS: Elderly patients with EGJAC have a longer course of disease and more clinical symptoms. However, the well-differentiated adenocarcinoma is well differentiated and the surgical resection rate is still high. Therefore, endoscopic and biopsy adaptations should be appropriately relaxed for elderly patients Disease, elderly is not an absolute contraindication for surgery.