贲门癌的生物学行为及其在外科治疗中的意义

Biological behavior of cardial cancer and its effect on surgical management

目的 研究贲门癌的生物学行为及其在外科治疗中的意义。 方法 回顾性调查施行根治性手术并具有完整临床病理资料的 46例贲门癌病例 ,采用全胃切除根治术或全胃切除根治联合胰脾切除 ,腹主动脉旁淋巴结清扫术者 2 7例。近端胃切除根治术 (D2 以上 )者 19例。分析贲门癌的Borrmann分型 ,癌肿浸润深度 (pT)、生长方式 ,各组、站淋巴结转移的频度和术后 5年生存的关系。结果 46例患者中BorrmannⅢ型占 76% (3 5例 ) ,5年生存率 40 % (14 / 3 5) ;Ⅳ型占 18% (8例 ) ,5年生存率为 0 ;Ⅱ型占 6% (3例 ) ,5年全部生存。pT2 占 3 1% (14例 ) ,5年生存率 64% (9/ 14 ) ,其中淋巴转移 10例 ,占 71% (10 / 14 ) ;pT3 占 15% (7例 ) ,5年生存 4例 ,淋巴结转移 6例 ;pT4 占 54% (2 5例 ) ,5年生存率 12 % (3 / 2 5) ,其中淋巴转移率 92 % (2 3 / 2 5)。癌肿呈浸润性生长者占 87% (40 / 46) ,5年生存率2 8% (11/ 40 ) ;呈膨胀性生长者占 13 % (6/ 46) ,5年全部生存。 结论 进展期贲门癌应行全胃切除的D2 以上根治术 ,必要时行联合脾。

Objective To study the biological behavior of cardial cancer and its influence on surgical management. Methods Complete clinicopathologic data of 46 cases with cardial cancer undergoing radical gastrectomy was investigated retrospectively. The relationships between tumor Borrmann type, depth of invasion, growth patter, lymph node metastasis and 5 year survival rate postoperative were analyzed. Results Of 46 cases, Borrmann type Ⅲ, Type Ⅳ and Type Ⅱ was 76%(35/46), 18%(8/46) and 6%(3/46) respectively; 5 year survival rate was 40%(14/35), 0(0/8)and 100%(3/3)respectively. In respect of the depth of invasion, pT 2 was 31%(14/46) cases with 71%(10/14) lymph node metastasis; and 5 year survival rate was 64%(9/14). pT 3 was 15%(7/46) cases with 86%(6/7) lymph node metastasis; and 5 year survival rate was 57%(4/7). And pT 4 was 54%(25/46) cases with 92%(23/25) lymph node metastasis; and 5 year survival rate was 12%(3/25). The growth pattern in 87%(40/46) cases was infiltrative; and 5 year survival rate was 28%(11/40); the growth pattern in 13%(6/46) cases was expansive; and 5 year survival rate was 100%(6/6). Conclusion D 2 + radical total gastrectomy shonld be performed on the developed cardial cancer, and if necessary, resection of body and tail of pancreas should be chosen.