胃癌患者肝转移和腹膜扩散的相关因素及其预后分析

Related factors and prognosis of hepatic metastasis and peritoneal dissemination In gastric cancer

目的探讨胃癌患者肝转移和腹膜扩散的相关临床病理因素和近远期预后以及姑息性手术对预后的影响。方法回顾性分析1994年8月至2005年7月间胃癌数据库资料中792例患者的临床病理资料和随访结果。结果本组患者肿瘤穿透浆膜、淋巴结转移、肝转移、全胃癌、未分化癌、BorrmannⅣ型、女性患者因素与腹膜扩散相关,而BorrmannⅣ型、淋巴结转移、腹膜扩散与胃癌肝转移相关(P＜0．05)。肝转移患者1年生存率低于腹膜扩散患者(P＜0．05)；而3、5年生存率两者差异无统计学意义(P＞0．05)。腹膜扩散组中姑息性切除术患者1年生存率高于旁路手术/喂食性造口术和剖腹探查患者(P＜0．05)；而肝转移患者3种手术者1、3、5年生存率比较,差异无统计学意义(P＞0．05)。结论有肝转移的胃癌患者近期预后比腹膜扩散患者差；姑息性切除术可改善腹膜扩散胃癌患者的近期生存率,而对肝转移患者影响不明显。

Objective To investigate the related factors and prognosis of peritoneal dissemination and hepatic metastasis in gastric cancer, and the impact of palliative surgery on the prognosis. Methods The elinieopathologie and follow-up data of the patients with gastric carcinoma treated in our hospital from Aug. 1994 to Jul. 2005 were analyzed retrospectively. Results The elinieopethologie factors correlated with peritoneal dissemination included serosal penetration, whole stomach cancer, undifferentiated type, female and hepatic metastasis, while those correlated with hepatic metastasis included Borrmann IV, lymph node metastasis and peritoneal dissemination （ P 〈 0.05 ）. The postoperative one-year survival rate of the patients with hepatic metastasis （H group） were lower than that of the patients with peritoneal dissemination （P group） （ P 〈 0. 05） . The one-year survival rate of the patients with peritoneal dissemination undergoing palliative resection was significantly higher than that of the patients undergoing by-pass operation or feeding neostomy, and exploratory laparotomy （ P 〈 0.05 ）, while there was no significant difference among the three groups of the patients with hepatic metastasis. Conclusion The short-term prognosis of the patients with hepatic metastasis is poorer than that of the patients with peritoneal dissemination. Palliative resection could improve the short-term survival rate of the patients with peritoneal dissemination, while it had no significant impact on the survival rate of the patients with hepatic metastasis.