胃癌腹膜转移手术治疗的探讨

Results of surgery in patients with gastric cancer extending to peritoneal metastasis

目的研究胃癌远处腹膜转移肿瘤姑息性切除的可行性问题。方法1994年9月至2004年9月共实施胃癌腹膜转移手术治疗44例,将其分为两组,胃癌姑息切除组29例,其中远处腹膜少处转移(P2)20例,远处腹膜多处转移(P3)9例;胃癌未切除组15例,其中P2 4例,P3 11例,探讨胃癌伴腹膜转移病人的存活率和影响存活率的因素。结果胃癌姑息切除组和未切除组的存活率差异有显著性(P=0.004),胃癌姑息切除组的中位生存时间为13.6个月,而未切除组的中位生存时间为4.5个月;胃癌切除组和非切除组内P2、P3组之间的存活率差异无显著性。结论腹膜转移的程度不是判断是否手术的标准,手术切除肿瘤病灶能提高P2和P3病人的存活率。

Objective To evaluate the benefits of palliative gastrectomy on the postoperative course of patients with gastric cancer and simultaneous metastases to the distant peritoneum. Methods Clinicopathologic characteristics of 44 patients who had gastric cancer and metastases to the distant peritoneum were analyzed retrospectively. The patients were divided into two groups,palliative gastrectomy group （ n =29） and non-gastrectomy group （ n = 15）. There were 20 cases of P2 and 9 cases of P3 in palliative gastrectomy group,4 cases of P2 and 11 cases of P3 in non-gastrectomy group,respectively. The prognostic factors for patients with gastric cancer extending to peritoneal metastasis were analyzed. Results Significant difference was found in survival curve between the gastrectomy group and non-gastrectomy （ P = 0. 004 ）. Mean survival time was 13.6 month in palliative gastrectomy group,while 4. 5 month in non-gastrectomy group. No significant difference was found in survival curve between P2 and P3 peritoneal metastases in palliative gastrectomy group and non-gastrectomy group. Conclusion Palliative gastrectomy improves the survival in either P2 or P3 peritoneal metastases. The decision to perform gastrectomy dose not depend on the extent of peritoneal metastases in gastric cancer.