胃癌D2根治术联合脾切除与否对疗效影响的比较研究

A comparative study on the efficacy of spleen-preserving modified D2 radical gastrectomy and D2 radical gastrectomy with splenectomy

目的比较胃癌D2根治术中联合脾切除与否对胃上部、上中部及全胃癌手术疗效的差异。方法1989年1月至1994年12月问，对112例肿瘤位于胃上部、上中部或全胃的患者施行了D2根治术．其中61例接受保脾改良淋巴结清除术（保脾组），51例接受D2根治术联合脾切除（切脾组）。回顾性分析两组患者在临床病理特征、5年生存率、术后并发症发生率和术后住院天数等方面的差异。结果两组胃癌患者在性别、年龄、肿瘤大小、肿瘤T分期和N分期及TNM分期间差异均无统计学意义（均P〉0．05）。保脾组和切脾组胃癌患者的术后5年总体生存率分别为41．0％和39．2％（P〉0．05）。保脾组Ⅰ、Ⅱ、Ⅲ、Ⅳ期胃癌患者的5年生存率分别为100．0％、66．7％、27．8％和17-4％．切脾组分别为100．0％、70．0％、26．7％和5．6％，两组各分期患者术后5年生存率差异均无统计学意义（P〉0．05）：保脾组和切脾组胃癌患者的术后并发症发生率分别为11．5％和27．5％，两组间差异有统计学意义（P〈0．05）；切脾组胃癌患者的术后平均住院天数（27．3d）长于保脾组（20．3d）（P=0．057）。结论对于胃上部、上中部或全胃癌，保脾改良淋巴结清除的D2全胃根治术不仅能取得与联合脾切除的耽全胃根治术相当的疗效，而且可以减少术后并发症的发生率。

Objective To compare the efficacy of modified D2 radical total gastrectomy with spleen-preserving and D2 radical total gastrectomy with splenectomy in patients with gastric cancer located in the upper third, upper and middle third and entire stomach. Methods One hundred and twelve patients with gastric cancer in the upper third, upper and middle third, or entire stomach underwent radical total gastrectomy between January 1989 and December 1994. Modified D2 total radical gastrectomy with spleen-preserving（spleen-preservation group）was performed in 61 patients, and 51 underwent D2 total radical gastrectomy with splenectomy（splenectomy group）. The differences in clinicopathological characteristics,5-year survival rate, incidence of postoperative complication and hospital stay between the two groups were analyzed retrospectively. Results There were no significant differences between the spleen-preservation group and the splenectomy group in gender, age, tumor size, T stage, N stage and TNM stage. The overall 5-year survival rate was 41.0% in the spleen-preservation group and 39.2% in the splenectomy group （P〉0.05）. The 5-year survival rates of patients with stage Ⅰ , Ⅱ, Ⅲ and IV were 100%, 66.7%, 27.8% and 17.4% in the spleen- preservation group, respectively, and were 100%, 70.0%, 26.7% and 5.6% in the splenectomy group, respectively （all P〉0.05）. The incidence of postoperative complication was lower in thespleen-preservation group （11.5% vs 27.5%, P〈0.05）. The mean hospital stay was longer in the splenectomy group （27.3 d vs 20.3 d,P=0.057）. Conclusion The efficacy of modified D2 radical total gastrectomy with spleen-preserving for patients with gastric cancer in the upper third, upper and middle third or entire stomach is similar to that of D2 radical total gastrectomy with splenectomy, and the spleen-preserving procedure is associated with decreased postoperative complication and improved survival.