原发胃癌切除术切端癌残留的有关因素

Factors Related with the Positive Cutting Edge Gastrectomy in the Primary Gastric Carcinoma Patients

目的:探讨原发胃癌切除术切端癌残留的发生率及有关因素。方法:回顾性分析北京协和医院1992年1月至 2002年1月原发性胃癌经腹切除术中切端癌残留的比例及有关因素。结果:442例原发胃癌经腹切除的病例中,标本切端癌残留率为12．9％。近切端癌残留18例(4．1％),远切端癌残留28例(6．3％),远近切端均有癌残留11例(2．5％)。根治性胃癌切除术切端癌残留率为10．1％,姑息性胃癌切除术切端癌残留为27．0％,二者差异显著(P<0．05)。弥漫浸润型者、分化程度较低及浸润较深者、肿块较大者、胃周转移的淋巴结数较多者切端癌残留比例明显增加(P<0．05)。结论:姑息手术、癌肿侵犯胃周组织、弥漫浸润型进展期胃癌、分化程度低、癌肿直径>5cm、或胃周转移淋巴结数≥5个者, 易发生切端癌残留。

Objective：To investigate the factors related with the positive cutting edge of gastrectomy in the primary gastric carcinoma patients for improving the future operation. Methods： Retrospectively analyzed the incidence of positive cutting edge and its related factors in all primary gastric carcinoma patients underwent gastreetomy through laparotomy from 1992 to 2002 in PUMC Hospital. Results： Among 442 cases, the total incidence of positive cutting edge was 12.9%. Positive proximal edge 18 cases （4.1%）, distal 28（6.3% ）, both proximal and distal 11 （2.5%）. The incidences in the radical and the palliative resection were 10,1% and 27.0% respectively （P 〈 0,05）. The incidence was significantly increased （P 〈 0.05） in patients with cancer of diffused infiltrative type, poor differentiation, larger mass, more positive peri - gastric lymph node. Couclusion： Significantly increased incidence of positive cutting edge existed in the patients underwent palliative resection due to late stage carcinoma or with infiltrated adjacent tissue, in the patients with cancer of diffused infiltrative type, poor differentiation, tumor mass larger than 5 cm in diameter of more than 5 positive i- gastric lymph nodes.