全胃切除联合脾脏切除治疗胃癌的选择

Simultaneous Splenectomy in Total Gastrectomy for Gastric Cancer

目的:探讨全胃切除治疗胃癌时是否要联合脾脏切除及如何抉择.方法:通过35例全胃切除联合脾脏切除治疗胃癌病例的总结.分析10或11组淋巴结转移率与病变部位、肿瘤大小、临床分期和病理组织类型的关系.结果:非根治性全胃切除联合脾脏切除治疗胃癌无助于提高患者生存率,相反由于联合脾脏切除后机体的免疫功能低下,使术后感染性并发症和手术死亡率增加.胃体部癌或胃体部侵润癌、肿瘤直径大于4cm、胃浆膜受浸润者,10或11组淋巴结转移率较高.结论:全胃切除联合脾脏切除治疗胃癌应持谨慎态度.如果不影响手术的根治性,保留脾脏十分重要.

To discuss the necessity and indication of simultaneous splenectomy in total gastrectomy. Methods: 35 cases of total gastrectomy with splenectomy for gastric carcinoma were analyzed in terms of its correlation with tumor size, location, clinicopathologic staging, histological patterns and groups 10 or 11 lymph nodes metastasis. Results: Palliative total gastrectomy combined with splenectomy did not improve survival rate, postoperative infection and mortality increased because of the lowered immune function of the host. Higher metastasis rates of 10th and 11th LN group were found in tumor of proximal and middle portion of the stomach, as well as in tumors greater than 4 cm in diameter or those with serosal invasion. Conclusions: Splenectomy should be cautiously considered in total gastrectomy for gastric carcinoma. It is mandatory to keep the spleen if its preservation does not influence the radical effect of the operation.