贲门腺癌行全胃切除术与近侧胃大部切除术的疗效对比

A COMPARATIVE STUDY OF THERAPEUTIC EFFECTS OF TOTAL VERSUS PROXIMAL SUBTOTAL GASTRECTOMY IN ADENOCARCINOMA OF THE GASTRIC CARDIA

作者２０年间手术切除４８５例贲门腺癌，其中２８３例行全胃切除术，２０２例行近侧胃大部切除术，通过疗效对比研究二种术式的选择。二组病人一般情况、年龄、性别、病期、肿瘤大小、手术根治程度、淋巴结有无转移、胃壁浸润程度和组织学类型相似，具有可比性。治疗结果：两种术式的１、３、５年生存率Ⅰ、Ⅱ期患者相似，Ⅲ期患者全胃切除组优于近侧胃大部切除组，３及５年生存率分别提高了１４．６％和１５．１％，Ｐ＜０．０５，差异有显著性意义。Ⅳ期患者如无远处转移，争取行扩大全胃切除术，如病变超过扩大全胃切除范围，局部条件许可，为解除梗阻或出血等症状，应尽量缩短手术时间，行姑息性近侧胃大部切除术或姑息性全胃切除术。

Abstract 485 patiens with adenocarcinoma of the gastric cardia operated in our hospital.283 cases weretreated with total gastrectomy, and 202 cases were treated with proximal subtotal gastrectomy. Theage, sex, clinical stage, size of tumour, radicality of surgical resection, lymph node involvement,tumour depth penetration and histological type had no significant difference in the two groups.Analysis of survival rates failed to demonstrate any significant difference between the two types ofsurgical operation for TNM stage Ⅰ and Ⅱ. Total gastrectomy resulted in significantly highersurvival rate than proximal subtotal gastrectomy for stage Ⅲ. The 3-and 5-year survival rateof TNM stage Ⅲ patients increased by 14.6% and 15.1%, respectively(P< 0. 05). Extended totalgastrectomy was usually applied for stage Ⅳ patients without distant metastasis. If the neoplasmhad spread beyond the confines of extended total gastrectomy, in order to eliminate obstruction orbleeding, palliative proximal subtotal gastrectomy or total gastrectomy should be considered.