胃癌累及胰腺的外科治疗与预后(附120例报告)

Surgical treatment and prognosis of gastric cancer invading the pancreas

目的探讨胃癌累及胰腺的外科治疗方法与预后的关系。方法回顾性分析我院1984年6月～2003年10月手术治疗累及胰腺的胃癌120例。结果本组120例中,根治切除组41例,姑息切除组23例,未切除组56例。根治组41例中经病理证实胰腺有癌细胞浸润者30例,占73.2%,淋巴结转移率为85.4%。其中No10、11淋巴结转移率为73.1%。术后102例得到随访,随访率为85%,1、3、5年的生存率分别为:根治切除组为73%、37%、17%,姑息切除组为22%、9%、4%,未切除组为9%、2%、0%。根治切除组1,3年生存率明显高于姑息性切除组和未切除组(P<0.05),5年生存率明显高于未切除组(P<0.01),但与姑息性切除组无显著性差异。姑息性切除组和未切除组1、3年生存率无显著性差异,但5年生存率明显高于未切除组(P<0.01)。结论胃癌累及胰腺的根治切除可提高1,3年生存率,选择合适的适应征是关键。姑息切除有助于改善生存质量,对改善预后意义不大。

Objective To investigate the methods and prognosis of surgical treatment of the gastric cancer invading the pancreas. Methods From June 1994 to Oct 2003, the clinical data of 120 patients with gastric cancer invading the pancreas were analyzed retrospectively. Results Among the 120 cases with gastric cancer invading the pa ncreas, the extended radical resection was performed in 41 cases, palliative resection in 23 cases, but non-resection in 56 cases. In extended radical resection g roup, the pathological results revealed pancreatic invasion in 30 cases (73.2%), l ymph node metastasis in 35 (85.4%), and No 10, 11 lymph node metastasis rates in 73 .1%. A follow-up of 102 cases revealed that the 1-, 3-, and 5-year survival r ates were 73%, 37%, and 17% in extended radical resection group, 22%, 9%, and 4% in palliative resectio n group, and 9%, 2%, and 0% in non-resection group respectively. The 1-, and 3 -year survival rates in extended radical resection group were significantly higher than those in palliative resection group and non-resection group (P<0.05). The 5 -year survival rate in extended radical resection group was significantly higher than that in non-resection group (P<0.01) but between extended radical resection group and palliative resection group significantly. The 1- and 3-year su rvival rate in palliative resection group was not significantly different from that in non-resection group, but the 5-year survival rate in palliative resection gro up was significantly higher than that in non-resection group (P<0.01). Conclusions As for the patients with gastric cancer invading the pancreas, extended radical resection can improve the 1- and 3-year survival rates and the selection of operation indications is crucial to the prognosis and palliative resection can improve the quality of life, but not the prognosis.