侵及胰腺晚期胃癌的外科治疗

Surgical treatment of advanced gastric cancer invading the pancreas

回顾性分析我院1995年1月1日-2000年1月1日施行的晚期胃癌侵犯胰腺手术46例患者的临床资料。结果46例患者中，根治性切除26例，姑息性手术20例。其中胃次全切除加胰体尾部和脾切除11例，全胃切除加胰体尾部和脾切除9例，胃次全切除加胰十二指肠切除3例，全胃切除加胰十二指肠切除2例，胃次全切除加胰体尾部切除1例；姑息性胃大部分切除术11例，短路手术（胃空肠吻合）7例，探查活检加空肠造瘘术1例，单纯探查活检术1例。随访40例，术后1、3和5年生存率，根治手术组分别为65．2％（15／23）、30．4％（7／23）和13％（3／23），姑息手术组分别为35．3％（6／17）、11．8％（2／17）和0。根治手术组术后1、3和5年生存率明显高于姑息手术组，x^2=4．62，P=0．030。初步研究结果提示，对晚期胃癌侵犯胰腺的患者，严格掌握手术适应证，选择合理的手术方式，注重患者围手术期的营养支持，这是降低并发症，提高联合胃胰切除手术成功率及远期生存率的重要因素。

From 1995 to 2000, 46 patients with advanced gastric cancer invading the pancrestic were analyzed retrospectively. Among 46 cases, radica resection was performed in 26 cases and palliative operation in 20 cases. Forty cases were followed up and 1,3 and 5 year survival rates were 65. 2%, 30. 4% and 13% in radical resection group and 35. 3%, 11.8% and 0 in palliative operation group,respectively. The 1-,3- and 5-year survival rates in radical resection group were significantly higher than those in palliative operation group,x^2 = 4.62, P= 0. 030. As for the patients with advanced gastric cancer invading the pancreas, the strict mastery of operation indications, the reasonable selection of surgical approaches and perioperative nutrition support will he the key points on decreasing complication, enhancing operative success rate and long-term survival rate.