胃癌R_2、R_3手术疗效的对比观察及评价

Effects of different lymphonode clearances on longterm survival of patients with gastric carcinoma

我们比较了胃癌Ｒ＿２、Ｒ＿３术后的近、远期疗效，并以病期和病理生物学行为为依据，探讨了合理选择两种手术的适应证。结果表明：Ｒ＿３术后１、３、５、７、１０年生存率均高于Ｒ＿２，以１、３、５年为著，与进行期病例（占８７％）有关。ＴＮＭⅠ期（Ⅰａ、Ⅰｂ）、Ｒ＿２、Ｒ＿３术后５年生存率基本相同，Ｒ＿２即可根治。Ⅱ、Ⅲａ期，Ｒ＿３优于Ｒ＿２。Ⅲｂ、Ⅳ期者，Ｒ＿３仍比Ｒ＿２提高，５年生存率２５．５％。早期癌及ＢｏｒｒｍａｎｎⅠ、Ⅱ型者两组相似，Ｒ＿３对ＢｏｒｒｍａｎｎⅢ和限局性ＢｏｒｒｍａｎｎⅣ型可提高疗效。Ⅰａ、Ⅰｂ期的胃壁内癌，淋巴结转移限于第一站者，Ｒ＿２可达到根治；Ⅱ期以上浸透浆膜含，Ｒ＿３可提高５年生存率。病理学的弥漫性生长方式、未分化癌及淋巴管癌栓者，生物学行为较差。对进行期病例应选择Ｒ＿３扩大根治术。Ｒ＿２、Ｒ＿３术后康复时间、并发症及死亡率主要与胃切除术式有关，与淋巴结清除范围无明显关系。

AbstractFrom 1980 to 1987,radical gastrectomy plus R_2 orR_3 lymphonode clearance was performed in 309 cases ofgastric carcinoma of which 179 were with R_2 and 1 30with R_3.The 1,3,5 years survival rate of R_3 was sta-tistically higher than that of R_2.The 5 years survivalrate of R_2 was nearly the same as R_3 in patients at stageⅠ(Ⅰa,Ⅰb)ahd borrmann type Ⅰ and Ⅱ, While R_3yields better results than R_2 at stage Ⅱ and Ⅲ a,it waseven 25.5%higher by R_3 than by R_2 at Ⅲ b and Ⅳ.R_3still benefits patrents at stage Ⅱ with serosa infiltra-tion,R_3 should also be performed in advanced caseswith poorly biologic behavior,such as diffuse growthpattern; undifferentiated cancer and lymphatic cancer-ous embosis. The recovery time,complications andmortalities of patients with R_2 or R_3 were mainly relat-ed to the model of gast rectomy not to the extent oflymphonode clearance.