根治性联合脏器切除在复发性胃癌治疗中的应用价值  

Application value of combined organ radical resection in patients with recurrent gastric cancer

作　　者：周军[1] 侯军丽[2] 李剑辉[2] 阿合提别克·塔布斯[2] 阿不都斯木·艾沙[2] 马博[2] 王捷[1] 

机构地区：[1]中山大学孙逸仙纪念医院胃肠外科,广州510120 [2]新疆医科大学第二附属医院普通外科,乌鲁木齐830063

出　　处：《中华胃肠外科杂志》2016年第3期292-295,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨根治性联合脏器切除在复发性胃癌中的应用价值。方法回顾性分析2008年1月至2013年12月间中山大学孙逸仙纪念医院和新疆医科大学第二附属医院收治的胃癌根治术后复发并接受再次手术、且具有完整临床病理资料的48例患者的临床资料，其中行再次根治性联合脏器切除手术者32例（根治手术组），行姑息性残胃联合其他脏器切除手术者16例（姑息切除组）。结果根治手术组1例（3．1％，1／32）术后第5天因并发肝肾综合征死亡；9例（28．1％．9／32）术后出现1～3种并发症，主要为肠外瘘、胰瘘、胆瘘和吻合口出血。姑息切除组术后仅1例（6．2％，1／16）发生了肺部感染和不完全性肠梗阻，术后并发症发生率明显低于根治手术组（P〈0．05）。根治手术组术后中位生存期为36．0月，较姑息切除组的11．5月明显延长（P〈0．01）；两组1、3年生存率分别为93．1％、72．4％、31．3％和18．8％，差异有统计学意义（P〈0．01）。单因素和多因素预后分析显示，临床分期（HR：3．106，95％CI：1．357-6．321，P=0．008）、腹膜种植（月R：10．167，95％口：3．230。35．234，P=0．000）及根治情况（HR：3．256，95％CI：1．267—9．389，P=0．009）是影响复发性胃癌患者预后的独立因素。结论复发性胃癌患者实施根治性联合脏器切除术可以获得较为满意的术后生存。但应进行术前多学科评估和术中准确的判断以严格掌握适应证，从而减少并发症发生率。Objective To investigate the outcomes after combined organ radical resection for the recurrent gastric cancer. Methods Complete clinicopathological data of 48 recurrent gastric cancer patients who received radical resection before and underwent reoperation again in the Sun Yat-sen Memorial Hospital and The Second Affiliated Hospital of Xinjiang Medical University from January 2008 to December 2013 were analyzed retrospectively. Of 48 patients, 32 received combined organ radical resection （radical group） and 16 received combined organ palliative gastric stump resection （palliative group）. Results In the radical group, one case （3.1%, 1/32） died 5 days after operation due to hepatorenal syndrome and 9 had postoperative complications （28.1%, 9/32）, including external intestinal fistula, pancreatic fistula, biliary fistula and anastomotic bleeding. In the palliative group, only one patient （6.2%, 1/16） had postoperative pneumonia and partial intestinal obstruction, with lower complication morbidity as compared to the radical group（P 〈 0.05）. The median survival time was significantly longer in the radical group （36.0 vs. 11.5 months, P 〈 0.01）. The 1- and 3-year survival rates were 93.1%, 72.4% in the radical group, and 31.3%, 18.8% in palliative group, whosedifferences were statistically significant. Multivariate Cox regression analysis showed that clinical stage （HR ：3.106, 95% CI：1.357 - 6.321, P = 0.008）, peritoneal metastasis （HR：10.167, 95% CI： 3.230 - 35.234, P = 0.000） and radical cure situation （HR ：3.256, 95% CI： 1.267 - 9.389, P = 0.009） were independent prognostic factors. Conclusion The combined organ radical resection can provide better survival for recurrent gastric cancer patients, while the indications should be controlled strictly with preoperative muhidisciplinary assessment and precise surgical judgment in order to decrease the complication.

关 键 词：胃肿瘤 复发性 根治性手术 联合脏器切除 预后 

分 类 号：R735.2[医药卫生—肿瘤]