残胃再发癌二次手术根治性的影响因素分析  

Risk factors of reoperation for remnant stomach cancer

作　　者：马振敕 张汝鹏[1] 王维佳[1] 王学军[1] 薛强[1] 梁寒[1] 

机构地区：[1]天津医科大学肿瘤医院胃部肿瘤科国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室,300060

出　　处：《中华胃肠外科杂志》2015年第2期139-142,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的：探讨残胃再发癌患者二次手术根治性的影响因素。方法回顾性分析天津医科大学肿瘤医院2003年1月至2014年5月收治的因残胃再发癌接受二次手术的93例患者的临床病理资料。通过单因素和多因素分析，了解影响二次手术根治性的临床病理因素。结果41例（44.1%）患者获根治性二次手术。单因素分析显示，初次手术重建方式、清扫范围、肿瘤N分期、TNM分期、复发时间、有无复发症状、证实复发与实施二次手术的间隔时间和二次手术前肿瘤标志物是否升高与能否行根治性二次手术有关（均P＜0．05）。 Logistic多因素回归分析显示，有复发症状（RR＝3.684；95％ CI：1．233～11．009；P＝0．020）和初次手术TNM分期为Ⅲ期（RR＝0．266；95％ CI：0．083～0．853；P＝0．026）是影响患者二次手术根治性的独立危险因素。结论有复发症状和初次手术时TNM分期为Ⅲ期的残胃再发癌患者二次手术的根治率较低。Objective To study the risk factors influencing patients with recurrent remnant stomach cancer to receive radical re-resection. Methods Clinicopathological data of 93 patients undergoing reoperation because of postoperative local recurrence of gastric carcinoma in Tianjin Medical University Cancer Institute and Hospital from January 2003 to May 2014 were analyzed retrospectively. Patients were divided into radical re-resection group and non-radical re-operation group. The characteristics of two groups were compared and evaluated by univariate and multivariate analysis. Results Among 93 patients, 41 were treated by radical re-resection and 52 by non-radical re-operation. Univariate analysis showed that reconstruction , lymph nodes dissection extent, N stage, TNM stages of the initial operation, interval between initial operation and recurrence, presenting symptoms, the interval between clinical symptom appearance or definite diagnosis and re-resection, tumor markers increasing before re-operation were significant factors associated with the chance to receive radical reoperation （P〈0.05）. Multivariate Logistic regression analysis revealed presenting symptoms （RR=3.684, 95% CI：1.233-11.009, P=0.020） and TNM stages of initial operation （RR=0.266, 95% CI：0083-0.853, P=0.026） were independent factors associated with the chance to radical reoperation （P〈0.05）. Conclusions Symptomatic recurrence and advanced TNM stages of initial operation are independent risk factors associated with patients who develope local recurrence of remnant stomach cancer to receive radical reoperation.

关 键 词：残胃再发癌 二次手术 根治性手术 危险因素 

分 类 号：R735.2[医药卫生—肿瘤]