贲门癌手术切缘癌残留相关因素分析

Parameters for Eliminating Residual Tumor at the Resection Margin of Gastric Cardia Carcinomas

目的:分析贲门癌切除手术后切缘镜下癌残留相关原因,为提高贲门癌外科治疗效果总结经验。方法:回顾性分析我院1995～2005年间收治的123例贲门癌临床资料,应用单因素分析方法探讨贲门癌切除手术上下切缘癌残留的相关因素。结果:123例贲门癌术后病理诊断切缘镜下癌残留11例,上切缘残留5例,下切缘残留6例,上下切缘均残留1例,残留率8.9%,切缘癌残留者与切缘无癌残留肿瘤最长径分别为9.5±3.8cm和6.5±3.1cm,P<0.05;不同肿瘤大小、不同TNM分期的切缘癌残留发生率有明显统计学差异(P<0.05),贲门癌肿瘤最长径>7cm以及TNM分期为Ⅳ期是切缘癌残留的危险因素。结论:在贲门癌外科治疗中,根据肿瘤最长径来决定贲门癌手术切除范围及术式以减少切缘癌残留有重要临床价值:肿瘤最长径超过7cm,肿瘤TNM分期至Ⅳ期患者应行全胃切除术,并保证足够长度的上切缘以减少切缘癌残留发生。

Objective： To analyze the factors that result in microscopic residual tumor（MRT） at the resection margin, and to explore the best way to reduce the occurrence of MRT after surgical treatment for carcinomas of the gastric cardia. Methods： The clinical data of 123 cardia carcinoma cases treated in the Third Hospital of Beijing University between 1995 and 2005 were retrospectively analyzed. The factors that resulted in MRT at the esophagus or gastric resection margin after surgical treatment were summarized. Results： Among the 123 cardia carcinoma patients there were 11 cases with MRT： 5 cases at the upper resection margin and 6 cases at the lower margin. The rate of MRT was 8.9%, the mean longest diameter of tumor in the MRT positive group and the MRT negative group was 9.5±3.8cm and 6.5±3.1cm, respectively（P〈0.05）. The rate of MRT showed a significant difference among different groups classified by the longest tumor diameter and different TNM stage （P〈0.05）. TNM stage was a risk factor for MRT. Conclusion： The longest tumor diameter should be considered when partial or total gastrectomy is selected as the surgical procedure for cardia carcinoma treatment. When the longest tumor diameter is over 7 cm and the TNM stage is more advanced, total gastrectomy should be considered and the allowance for the upper resection margin should be ensured.