不同时期胃癌浸润邻近器官情况及其外科治疗与预后分析  

Surgical management and prognosis of gastric cancer with adjacent organ invasion in different phases

作　　者：吴晖[1] 姚宝国[1] 何裕隆[1] 徐建波[1] 蔡世荣[1] 张信华[1] 王亮[1] 詹文华[1] 

机构地区：[1]中山大学附属第一医院胃肠胰外科、中山大学胃癌诊治中心,广州510080

出　　处：《中华消化外科杂志》2013年第7期490-495,共6页Chinese Journal of Digestive Surgery

基　　金：卫生部科研基金（W2011WA148）

摘　　要：目的探讨胃癌浸润邻近器官数目、浸润器官及其外科治疗与预后的变化趋势。方法回顾性分析1994年8月至2010年3月中山大学附属第一医院收治的1580例接受手术治疗胃癌患者临床资料，依入院时间分为阶段1（1994年8月至2000年12月）、阶段2（2001年1月至2005年12月）、阶段3（2006年1月至2010年3月）3组，比较各组患者胃癌浸润邻近器官情况及外科治疗与预后。计数资料采用χ2检验，计量资料采用单因素方差分析，采用寿命表法计算累计生存率，Kaplan-Meier法绘制生存曲线，多因素分析采用COX回归模型。结果阶段1、2、3组患者胃癌浸润邻近器官的总体发生率分别为34．67％（130／375）、27．08％（117／432）和26．65％（206／773），3组比较，差异有统计学意义（χ2=8．669，P〈0．05）。其中，胃癌浸润1个器官、≥3个器官的发生率3组依次下降（χ2=6．301，6．253，P〈0．05）；胃癌浸润2个器官的发生率3组比较，差异无统计学意义（χ2=3．254，P〉0．05）。胃癌浸润胰腺、脾脏的发生率3组比较，差异均无统计学意义（χ2=1．861，5．376，P〉0．05）；胃癌浸润胰腺＋脾脏的发生率3组依次升高（χ2=9．404，P〈0．05）；胃癌浸润胰腺和脾脏以外其他器官的发生率3组依次降低（χ2=27．247，P〈0．05）。阶段1、2、3组患者的总体根治性切除率分别为80．87％（307／375）、85．19％（368／432）和87．71％（678／773），3组比较，差异有统计学意义（χ2=11．724，P〈0．05）。其中，胃癌浸润1个器官者的根治性切除率3组依次升高（χ2=9．520，P〈0．05）；胃癌浸润2个及≥3个器官者的根治性切除率3组比较，差异无统计学意义（χ2=3．388，1．491，P〉0．05）。胃癌浸润胰腺、脾脏、胰腺＋脾脏者的根治性切除率3组比较，差异均无统计学意义（χ2=1．843，0．303，1．706，P〉0．05）；胃�Objective To investigate the tendency of organs invaded, surgical treatment and prognosis in patients with gastric cancer. Methods The clinical data of 1580 patients with gastric cancer who received surgical treatment at the First Affiliated Hospital of Sun Yat-Sen University from August 1994 to March 2010 were retrospectively analyzed. All patients were divided into phase 1 group （from August 1994 to December 2000） , Phase 2 group （January 2001 to December 2005） and phase 3 group （January 2006 to March 2010） according to the admission time. The organs invaded, surgical modality and prognosis were compared among the 3 groups.All data were analyzed using the chi-square test or analysis of variance. The accumulative survival rates were culculated by life table. Factors might have influence on the prognosis were analyzed by the Kaplan-Meier method and Log-rank test. COX regression model was used for multi-factor analysis. Results The ratios of organ invasion were 34.67% （130/375） , 27.08% （117/432） and 26.65% （206/773） in phase 1, 2, 3 group respectively, with significant differences （χ2 = 8. 669, P 〈 0.05 ）. The ratios of single organ and 3 organs （ or above） invasion were significantly decreased （χ2 = 6. 301, 6. 253, P 〈 0.05 ）. There was no significant change in the ratios of 2 ograns invasion （χ2= 3. 245, P 〉 0.05 ）. There were no significant differences in the ratios of pancreatic or splenic invasion among the 3 groups （χ2 = 1. 861, 5. 376, P 〉 0.05 ）. The ratio of pancreatic ＋ splenic invasion increased significantly （χ2 = 9.404, P 〈 0.05 ）, and the ratio of other organs invasion decreased significantly （2χ2 = 27. 247, P 〈 0.05 ）. The radical resection rate of the 3 groups were 80.87% （ 307/375 ）, 85.19% （ 368/432 ） and 87.71% （678/773）, respectively （χ2= 11. 724, P 〈 0.05 ）. The resection rate of patients with single organ invasion was significantly increased （χ2 = 9. 520, P 〈 0.05 ）. There were no significant di

关 键 词：胃肿瘤 器官浸润 外科手术 预后 阶段 

分 类 号：R735.2[医药卫生—肿瘤]