T_(4a)期胃癌患者行微创手术后的生存状况与长期效果研究  

Survival and long-term effects of T4a gastric cancer patients after minimally invasive surgery

作　　者：石海红[1] 许海静 袁其华 Hai-hong Shi;Hai-jing Xu;Qi-hua Yuan(Department of General Surgery,Yidu Central Hospital,Weifang,Shandong 262500,China)

机构地区：[1]山东省潍坊市益都中心医院普外三科,山东潍坊262500

出　　处：《中国内镜杂志》2018年第9期63-67,共5页China Journal of Endoscopy

摘　　要：目的探究T4a期胃癌患者行微创手术后的生存状况与长期效果。方法回顾性分析2010年1月-2013年1月该院收治的93例T4a期胃癌患者的临床资料,所有患者均行腹腔镜T4a期胃癌根治术治疗,术后经门诊、电话等方式进行随访,其中5例患者失访,以未失访的88例患者作为研究对象。分析患者5年生存状况,其中49例患者存活为存活组,39例患者死亡为死亡组。对T4a期胃癌患者行微创手术后死亡相关因素进行单因素和Logistic多因素分析。结果术后5年内48.86%(43例)患者无病生存;6.82%(6例)患者带瘤生存,44.32%(39例)患者死亡,其中39.77%(35例)患者因复发或转移死亡。单因素分析结果显示,肿瘤直径、肿瘤部位、联合脏器切除、肿瘤N分期、Lauren分型、淋巴结转移率、淋巴结转移范围、淋巴结转移数目与T4a期胃癌患者行微创手术后死亡有密切相关性(P<0.05)。Logistic多因素分析结果显示,联合脏器切除、肿瘤N2分期、淋巴结转移率>40%、淋巴结转移范围大、淋巴结转移数目多为T4a期胃癌患者行微创手术后死亡的危险因素(P<0.05)。结论 T4a期胃癌患者行微创手术后5年生存状况不佳,联合脏器切除、肿瘤N2分期、淋巴结转移率>40%、淋巴结转移范围大、淋巴结转移数目是其术后死亡的危险因素,应对此类患者加强监测,以改善预后。Objective To investigate the survival and long-term effects of minimally invasive surgery for patients with T4a gastric cancer.Methods The clinical data of 93 cases of T4a gastric cancer treated from January 2010 to January 2013 were retrospectively analyzed.All the patients underwent laparoscopic T4a radical gastrectomy and followed up by clinic and telephone after surgery.During the follow-up period,5 patients were lost to follow-up,and the other 88 patients who were not lost as study objects.The 5-year survival status of the patients was analyzed.Among them,49 patients survived in the survival group and 39 patients died in the death group.The univariate and Logistic multivariate analysis of the related factors of death after minimally invasive surgery in patients with T4a gastric cancer were made.Results Within 5 years postoperatively,48.86%(43 patients)had disease-free survival,6.82%(6 patients)had tumor survival,44.32%(39 patients)died,and 39.77%(35 patients)died of relapse or metastasis.Univariate analysis showed that tumor diameter,location,combined organ resection,tumor N staging,Lauren classification,lymph node metastasis,lymph node metastasis range,number of lymph node metastasis,and T4a gastric cancer patients were closely related to death after minimally invasive surgery(P<0.05).Logistic multivariate analysis showed that combined organ resection,tumor N2 stage,lymph node metastasis rate>40%,lymph node metastasis range,and lymph node metastasis were mostly risk factors for death after T4a-stage gastric cancer patients underwent minimally invasive surgery(P<0.05).Conclusions The survival of patients with T4a gastric cancer after 5 years of minimally invasive surgery is not good,combined organ resection,tumor N2 stage,lymph node metastasis rate>40%,lymph node metastasis range,the number of lymph node metastasis is a risk factor for its death.The monitoring of such patients should be strengthened to improve the prognosis.

关 键 词：胃癌 T4a期 腹腔镜胃癌根治术 预后 因素 

分 类 号：R735.2[医药卫生—肿瘤]