胃癌术后复发的临床分析

The management of postoperative recurrence of gastric carcinoma

目的研究胃癌术后复发的临床特点，总结处理经验。方法回顾性分析2002年1月至2008年12月收治的78例胃癌术后复发病例的临床资料。结果本组78例胃癌术后复发患者的中位复发时间为术后16．8个月。多因素分析显示首次手术的根治程度、切缘情况、肿瘤分化程度、TNM分期直接影响肿瘤的复发时间（P〈0．05）。术后复发转移部位与首次胃癌手术方式无明显关系（P〉0．05）。再手术36例，其中因单一肝转移行肝叶或肝段切除3例，因局部复发再手术33例。结论首次手术的根治程度、切缘情况、肿瘤分化程度、TNM分期是胃癌术后复发的主要因素。应根据具体情况采取包括手术在内的综合治疗积极措施，以改善患者的生活质量及预后。

Objective To study clinical characteristics of postoperative recurrence after a cure intent resection for gastric cancer. Methods From 2002 to 2008, 78 patients with recurrent cancer after curative gastrectomy for gastric cancer hospitalized in our department were enrolled in this study. Results The average recurrent time was 16. 8 months. The multi-factor analysis demonstrated that the original surgical parameters such as radical degree, incision margin, differentiation, TNM stages were all factors influencing the recurrent time （ P 〈 0. 05 ）. There was no remarkable difference in recurrent positions among different surgical modalities （ P 〉 0. 05 ）. Thirty-six patients received reoperation, of which 3 patients underwent hepatectomy for single liver metastasis, and 33 patients received resection for local recurrence. Conclusions Radical resection incision margin, tumor differentiation, TNM stages at the first surgery were factors influencing recurrent gastric carcinoma after resection. Tumor recurrence should be treated with comprehensive therapy including re-operation to improve the prognosis and quality of life.