全胃切除术治疗胃底贲门癌的远期疗效  

Long-term therapeutic effects of total gastrectomy in cancer of the cardia and stomach fundus

作　　者：黄昌明[1] 张祥福[1] 卢辉山[1] 张建中[1] 吴心愿[1] 官国先[1] 王川[1] 

机构地区：[1]福建医科大学附属协和医院肿瘤科,福州350001

出　　处：《中华外科杂志》2003年第10期729-732,共4页Chinese Journal of Surgery

摘　　要：目的　探讨全胃切除术治疗胃底贲门癌的临床价值。　方法　对 513例胃底贲门癌患者施行根治性手术 ,其中全胃切除术 (TG组 ) 3 2 6例 ,近侧胃大部切除术 (PG组 ) 187例。对 2组患者的5、10年生存率 ,以及术后并发症的发生率和病死率进行对照分析。　结果　TG组 5、10年生存率分别为 43 6%、2 4 5% ,明显高于PG组的 3 3 9%、14 1% ,2组比较差异具有显著性意义 (χ2 =4 42 1、P <0 0 5,χ2 =5 72 6、P <0 0 5)。TG组术后并发症的发生率和病死率分别为 14 7%、3 1% ,PG组分别为10 2 %、2 1% ,2组比较差异无显著性意义 (χ2 =1 796、P >0 0 5,χ2 =0 0 82、P >0 0 5)。结论　对于肿瘤大于 3 0cm或有淋巴结转移的Ⅲ期胃底贲门癌患者 ,应施行全胃切除术 ,以提高远期疗效。全胃切除术不但不会增加术后并发症发生率和病死率 。Objective To evaluate total gastrectomy for the treatme nt of cancer of the cardia and stomach fundus. Methods Five hundred and thirteen patients with cancer of the cardia and stomach fundus underwent radical resection. Of them, 326 were treated using total gastrectomy(group TG); and 187, using proximal gastrectomy(group PG). The 5 year and 10 year survival rates and the postoperative complication rate and mortality rate were followed up and compared in the two groups. Results The 5 year and 10 year survival rates of group TG were 43 6% and 24 5%, of group PG were 33 9% and 14 1%, respectively, and the difference was statistically significant (χ 2=4 421,P<0 05,χ 2=5 726, P<0 05). The postoperative complication rate and mortality rate of group TG were 14 7% and 3 1%, of group PG were 10 2% and 2 1%, respectively, and the difference was not statistically significant (χ 2=1 796,P>0 05,χ 2=0 082,P>0 05). Conclusions To improve long term therapeutic effects, total gastrectomy should be recommended for stage Ⅲ patients with cancer of the cardia and stomach fundus when tumor size is bigger than 3 0 cm or lymph node metastasis occur. The postoperative complication rate and mortality rate should not be increased and the esophagitis of gastroesophageal reflux should be avoided in the patients treated using total gastrectomy.

关 键 词：全胃切除术 胃底贲门癌 治疗 远期疗效 病死率 患者 发生率 PG 显著性 

分 类 号：R735.2[医药卫生—肿瘤]