不同手术方式对胃中部癌患者预后的影响  

Influence of prognosis on patients with central gastric cancer by different ways of operation

作　　者：李少伟[1] 陶凯雄[2] 

机构地区：[1]武警北京总队医院外一科,北京100027 [2]华中科技大学同济医学院附属协和医院胃肠外科,湖北武汉430022

出　　处：《中国医药导报》2013年第33期39-41,47,共4页China Medical Herald

基　　金：国家自然科学基金项目(编号81172294)

摘　　要：目的 探讨不同胃切除手术方式对胃中部癌患者预后的影响.方法 回顾性分析2010年1月～2012年12月武警北京总队医院收治的108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患者58例（DG组）,行开腹全胃切除术患者50例（TG组）,比较两组患者临床病理资料、术中情况、并发症、术后5年的生存率;采用Cox回归模型进行危险因素分析.结果 ①TG组肿瘤平均直径、浸润深度、淋巴结转移、TNM分期、WHO分期、Borrmann分型、分化程度比例等与DG组比较,差异均有统计学意义（P＜0.05）;癌胚抗原两组差异无统计学意义（P＞0.05）.②TG组联合脏器切除比例、手术时间、并发症、清扫淋巴结数目及阳性数均高于DG组,差异均有统计学意义（P＜0.05）;两组术后住院时间比较,差异无统计学意义（P＞0.05）.③DG组与TG组的中位生存期分别为61.5、77.2个月,1、3、5年累计生存率分别为95％、67％ 、59％和81％ 、63％、49％,差异无统计学意义（P＞0.05）.Cox同归分析表明,根治程度、脏器侵犯、淋巴结转移为胃中部癌的独立预后因素（P＜ 0.05）.单因素分析表明,手术方式、肿瘤直径、并发症为预后的相关因素;肿瘤Borrmann分型、分化程度、组织学分型、手术时间对预后无显著影响（P＞0.05）.结论 对胃中部癌患者来说,预后不受手术方式的影响,只要能达到根治的目的,选择远端胃大部切除的手术方式是可行的.Objective To investigate the influence of prognosis on patients with central gastric cancer by different ways of operation.Methods 108 patients with central gastric cancer from January 2010 to December 2012 in Beijing Armed Police Corps Hospital were selected.58 cases in DG group were treated with distal gastrectomy,while 50 cases in TG group were treated with total gastrectomy.Clinicopathologic data,intraoperative situation,complications,5-year survival rates were compared between the two groups.The prognostic risk factors were evaluated by Cox multivariate analyses.Results ①The differences of tumor average diameter,infiltration depth,lymphatic metastasis,TNM stages,WHO stages,Borrmann types,differentiation proportion between TG group and DG group were statistically significant （P ＜ 0.05）; the differences of carcino-embryonic antigen between TG group and DG group was not statistically significant （P ＞ 0.05）.②）Multi-visceral resection rate,operation time,complications,the cleaning lymph node number and positive number of TG group were all higher than those of DG group,the differences were statistically significant （P ＜ 0.05）; the difference post operation hospitalization time of the two groups was not statistically significant （P ＞ 0.05）.③The median survival time of DG group and TG group were 61.5 and 77.2 months respectively; the 1,3,5 years survival rates of DG group and TG group were 95％,67％,59％ and 81％,63％,49％ respectively,the differences were not statistically significant （P ＞ 0.05）.The cure degree,organ violation,lymphatic metastasis were the independent prognostic factors according to the Cox regression analysis （P ＜ 0.05）.Operation method,tumor diameter,complications were the relevant factors according to the single factor analysis; no obvious effect on prognosis on Borrmann types,differentiated degree,histological classification,operation time （P ＞ 0.05）.Conclusion It is feasible to select the distal stomach resection to achieve the purpose of

关 键 词：胃肿瘤 中部 胃切除术 预后 

分 类 号：R735.2[医药卫生—肿瘤]