Ⅳ期胃癌外科手术治疗的临床价值

Clinical values of surgical management for stage Ⅳ gastric cancer

目的探讨Ⅳ期胃癌外科手术治疗的临床价值。方法收集1990～2000年间527例Ⅳ期胃癌患者的手术及病理资料,其中92例行根治性手术,204例行姑息性切除术,231例行胃肠吻合术或开腹探查术。比较各种手术方式术后1、3、5a生存率。结果施行根治性手术后1、3、5a生存率分别为58.4%、20.8%和9.7%,姑息性切除术为45.8%、11.2%和4.6%,而未切除者为11.0%、3.1%和0%,组间比较差异有统计学意义(P<0.05)。在无远处转移的病例中,根治性手术后1、3、5a生存率分别为68.1%、37.5%和18.6%,较姑息手术者的57.5%、10.0%和3.8%明显提高(P<0.05);在有远处转移的患者中,姑息性切除术后1、3、5a生存率分别为48.7%、17.3%和3.8%,较未切除者的8.5%、0和0明显提高(P<0.05)。结论无远处转移的Ⅳ期胃癌患者行根治性手术可提高手术疗效;对有远处转移的Ⅳ期胃癌,姑息性切除可延长生存期。

Objective To evaluate the clinical values of surgical management in patients with stage Ⅳ gastric cancer. Methods The surgical and pathological data of 527 patients with stage Ⅳ gastric cancer from 1990 to 2000 were collected, among whom 92 were performed radical resection, 204 palliative resection, and 231 gastrojejunostomy or laparotomy. The postoperative 1-, 3- and 5-year survival rate were compared among the patients with different surgical management. Results The postoperative 1-, 3- and 5-year survival rate were 58.4% , 20.8% and 9.7% , respectively in the radical resection group, 45.8% , 11.2% and 4.6% , respectively in the palliative resection group, and 11.0% , 3.1% and 0% , respectively in the non-resection group. There were significant differences among the three groups（P〈0.05）. In the cases without distant metastasis, the postoperative 1-, 3- and 5-year survival rate of radical resection group （68.1%, 37.5% and 18.6%, respectively） were significantly higher than those of palliative resection group （57.5%, 10.0% and 3.8% , respectively; P 〈 0.05）. And in those with metastasis, the corresponding survival rate of palliative resection group （48.7% , 17.3% and 3.8% , respectively） were significantly higher than those of non-resection group （8.5% , 0% and 0% , respectively; P 〈 0.05）. Conclusion It is beneficial to perform radical resection for stage Ⅳ gastric cancer patients without metastasis. In the same way, palliative resection can prolong the survival time for those with metastasis.