615例胃癌行全胃切除术的远期疗效  

Long-term effect of total gastrectomy on 615 cases with gastric cancer

作　　者：张建中[1] 卢辉山[1] 黄昌明[1] 吴心愿[1] 官国先[1] 王川[1] 郑朝晖[1] 张祥福[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：《中华胃肠外科杂志》2002年第1期13-16,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨全胃切除术治疗胃癌的意义及消化道重建的最佳术式。方法总结分析我科615例胃癌行全胃切除术及各种消化道重建术式的临床资料。结果本组随访580例,随访率94.3%。总的1、3、5年生存率分别为77.4%、45.3%、32.5%。其中根治性全胃切除术507例,姑息性切除术108例,其5年生存率分别为48.9%与5.9%,差异有非常显著性意义(P<0.01)。对比同期近侧胃大部切除术466例5年生存率20.2%,全胃切除术的5年生存率明显高于近侧胃大部切除术(P<0.05)。全胃切除术后并发症发生率为11.4%,手术死亡率为2.9%。消化道重建术式采用空肠原位间置代胃术,对术后生活质量方面具有较好的效果。结论除皮革样胃癌、胃体癌、多原发癌以及残胃癌应行全胃切除术外,贲门区癌无论早、晚期,只要一般条件许可,应常规行全胃切除术,以提高生存期。消化道重建术采用空肠原位间置代胃术可取得较好的生活质量。Objective To evaluate the value of total gastrectomy and the optimal reconstruction for gastric cancer.Methods Clinical data of 615 patients with gastric cancer undergone total gastrectomy in our department from June 1972 to June 2000 were reviewed respectively.Results 580 cases were followed up. 1 ,3 and 5 year survival rates were 77.4%, 45.3%and 32.5%respectively. Among them, 507 patients underwent curative total gastrectomy, while 108 patients underwent non curative total gastrectomy. The 5 year survival rate of curative total gastrectomy was 48 9%as compared to 5 9%of non curative total gastrectomy (P< 0 05). At the same period the 5 year survival rate of proximal subtotal gastrectomy was 20 2%, which was significantly lower than that of total gastrectomy (P< 0 05). The incidence of complication was 11 4%and operation mortality rate was 2 9%in total gastrectomy. Jejunal original site interposing replacement procedure modified by our staff was the choice of reconstruction following total gastrectomy, which could improve quality of life postoperatively. Conclusions Gastric cancer, including corpus carcinoma, multiple primary carcinoma and stump carcinoma, should be recommended to receive total gastrectomy. If only the operation is possible for the patient, cancer of the cardia should be treated with total gastrectomy as well in order to improve 5 year survival rate. Jejunal original site interposing replacement may result in a better quality of life.

关 键 词：外科手术 胃切除术 预后 胃癌 远期疗效 

分 类 号：R735.2[医药卫生—肿瘤]