胃切除方式对胃中部癌患者预后的影响  

Impact of the extent of gastric resection on the prognosis of patients with middle one-third gastric cancer

作　　者：陶克龙[1] 黄昌明[1] 林建贤[1] 郑朝晖[1] 李平[1] 谢建伟[1] 王家镔[1] 

机构地区：[1]福建医科大学附属协和医院胃外科,福州350001

出　　处：《中华胃肠外科杂志》2013年第2期155-159,共5页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨胃切除方式对胃中部癌患者预后的影响。方法回顾性分析1998年1月至2005年12月间福建医科大学附属协和医院收治的222例胃中部癌患者的临床资料，其中行开腹远端胃大部切除术66例（DG组），行开腹全胃切除术患者156例（TG组），比较两组患者术后5年的生存率。结果DG组和TG组术后5年生存率分别为63．9％和49．8％，差异具有统计学意义（P〈0．05）。但相比之下，TG组患者肿瘤更大、分期更晚、肿瘤位于小弯侧者居多（均P〈0．01）。按TNM分期进行分层预后分析显示，相同病期的两组患者术后5年生存率的差异均无统计学意义（均P〉0．05）。无论是以4cm、5cm还是6cm作为近切缘截点，不同近切缘距离患者5年生存率的差异均无统计学意义（均P〉0．05）。多因素预后分析显示，浸润深度、淋巴结转移和TNM分期是独立预后影响因素（均P〈0．05）；而胃切除方式并不是独立预后因素（P〉0．05）。结论胃中部癌患者如果能够达到根治手术的要求，其预后不受胃切除方式的影响，行远端胃大部切除术是可行的。Objective To investigate the impact of the extent of gastric resection on the prognosis of patients with middle one-third gastric cancer. Methods From January 1998 to December 2005, 222 patients with middle one-third gastric cancer underwent D2 radical resection in the Affiliated Union Hospital, Fujian Medical University. Among them, 66 underwent distal gastrectomy（DG group）, while 156 underwent total gastrectomy（TG group）. The 5-year survival rates were compared between two groups. The prognostic factors were evaluated by univariate and multivariate analyses. Results The 5-year survival rates of DG group and TG group were 63.9% and 49.8% respectively, with significant difference （P〈0.05）. Nevertheless, compared to DG group, the tumors in TG group had bigger size, later TNM stage, and higher proportion of locating lesser curvature of stomach （all P〈0.01）. Multivariate analysis revealed that invasion depth, lymph node metastasis and TNM classification were independent prognostic factors （all P〈0.05）, but the extent of gastric resection was not（P〉0.05）. Conclusion If curative resection can be performed, the long-term prognosis of patients with middle one-third gastric cancer is not affected by the extent of gastric resection, and distal gastrectomy is feasible.

关 键 词：胃肿瘤 中部 胃切除术 近切缘 预后 

分 类 号：R735.2[医药卫生—肿瘤]