Ⅰ、Ⅱ期胃癌手术方式选择的探讨(附129例报道)

THE SELECTION OF OPERATION TYPES FOR PATIENTS WITH STAGE I AND II GASTRIC CARCINOMA

我院自1964年4月至1982年12月共收治Ⅰ期胃癌14例,行R_2术8例,胃大部分切除6例,其5、10年生存率相似。Ⅱ期胃癌115例,行R_2术64例,胃大部分切除51例,其5年生存率相似,10年生存率R_2术似较高。就理论而言,Ⅰ期胃癌应无淋巴结转移,则胃大部分切除已达治疗目的,但临床实践中必然存在肉眼判别误差,第Ⅰ站淋巴结是否有转移难以判断,故术中认为属Ⅰ期病例,行R_1术多可达到治疗目的。Ⅱ期病例应无第Ⅱ站淋巴结转移,故作R_1术即可达到治疗目的。但Ⅱ期病例中,多数病灶已侵及肌层甚至浆膜层,则第Ⅱ站淋巴结转移可达30％以上,即部分病例已属Ⅲ期,临床实践中Ⅱ、Ⅲ期肉眼实难判断,故术中认为属Ⅱ期病例,应行R_2术或选择性R_3术较合理。

From Apr. 1964 to Dec. 1982, one hundred and twenty nine patients win stage Ⅰ and Ⅱ gastric carcinoma underwent two different operation types, at our hospital. A-mong the 14 patien ts in stage Ⅰ . 8 cases underwent R 2 radical gastrectomy, 6 cases underwent subtotal gastrectomy. Their 5- and 10-year survival rates were similar Among the 115 cases in stage Ⅱ 64 cases underwent R 2 operation and 51 cases subtotal gastrectomy. Their 5-year survival rates were similar. However, the 10-year survival rate was somewhat higher in the R 2 group than that in the subtotal gastrectomy group . According to the infiltrating extent of the tumor and metastases of the regional lymph nodss, it seems that the subtotal gastrectomy is reasonable theoretically for stage Ⅰ cases, because there is no metastatic lymph nodes in these patien ts, However, for there patients R 1 radical operation should be chosen in clinical practice, because we could not judge macroscopically whether the lymph nodges are affected. In clinical practice , for the same recason , we could not differ entiate stage Ⅱ with stage, Ⅲ gastric carcinoma. Once the gastric carcinoma is determined clinically to be stage Ⅱ, we prefer to perform R 2 or selective R 3 operation.