胃癌外科治疗30年回顾

A Reappraisal of the Surgical Treatment of Gastric Cancer Review of 30-year Experience

自1958年1月至1987年12月,我院外科共收治胃癌2722例,其中手术2412例(手术率88.6%),切除1720例(切除率71.3%).切除者术后总5年生存率为34.8%.Ⅰa、Ⅰb、Ⅱ、Ⅲa、Ⅲb及Ⅳ期胃癌切除者术后5年生存率分别为98.7%、80.2%、65.7%、44.8%、23.1%及10.8%.随病期趋晚,生存率逐步降低,且各期间差异显著,说明国际胃癌TNM分期法能较好地体现分期与预后理应具备的一致性.若将全组分两个阶段进行分析,则近期组(1984～1987年)5年生存率为41.4%.既往组(1958～1983年)为32.6%.分析还显示5年生存率的提高主要为早、中期病例相对增多所致, 说明早期诊治是提高胃癌生存率的关键.近期组根治性切除术后5年生存率已达61.2%.比较不同根治切除范围(D_1、D_2及D_3术)对各期胃癌的疗效,提示应根据癌肿的部位、分期及生物学特性来制定每一胃癌病例的具体手术方案.

From January 1958 through December 1987, 2722 cases of gastric cancer were admitted to our department, with an operability of 88.6%(2412 cases) and a resectability of 71.3%(1720 cases). The overall 5-year survival rate of all the resectable cases was 34.8%, while the corresponding figures for cases belonging to stages Ia, Ib, II, III, IIIb, and IV were 98.7%, 80.2%, 65.7%, 44.8%, 23.1%, and 10.8% respectively. The data indicated that there were significant differences between the stages, and that an almost linear correlation existed between the staging and the prognosis. If the whole series is divided into 2 groups of different periods, the 5-year survival rate of the group 1984-1987 was 41.4%, while that ofthe group 1959-1983 was 32.6%. The improvement was mainly due to the increase in early and middle-stage cases in the recent group, indicating that early diagnosis is still the key point for ameliorating the therapeutic results. The 5-year survival rate of the radically treated cases of the recent group has reached 61.2%. The results of different extents of dissection (D1、D2 and D3) as applied to cases of various stages alluded to the adoption of a more rational approach, that the operation should be individually planned for each case according to the site, stage and biological behavior of the tumor involved.