胃癌患者手术治疗合理方案的临床分析

Clinical Study on surgical treatment for gastric cancer patients

目的对与胃癌生存率有关的因素应进一步深入研究,找出预后因素,以指导临床规范外科治疗,并在此基础上探讨提高胃癌疗效的方法 ,以提高患者的生存率。同时为临床实践提供理论依据。方法选择2001年10月至2005年4月辽河油田中心医院普外科术前或术后经病理确诊,并在该院进行手术治疗的407例未失访原发胃癌病例,进入研究队列。Kaplan-eier法对资料的预后因素进行生存率分析,采用Log-ankTest和Cox比例风险模型对与胃癌术后生存率有关的因素进行单因素分析和多因素分析。结果①所有胃癌患者中,死亡病例为249例占61.1%,生存病例为158例占38.9%。其中总的一年生存率为71.87%,3年生存率为45.33%,5年生存率为40.05%。总的半年复发率为13.27%,一年复发率为25.21%,三年复发率为46.02%,五年复发率为51.54%;②多因素分析影响胃癌患者预后的因素有:Borrmann大体分型,手术根治度,化疗时间,TNM分期。结论①胃癌的Borrmann大体分型,TNM分期是影响胃癌患者术后生存的生物学因素。在指导治疗和决定其预后方面起着重要作用;②外科手术是治疗胃癌最有效的手段,根治性切除是使其达到治愈的唯一途径。

Objective To investigate appropriative way to improve curative effect and survival rate of surgical therapy for gastric cancer.Methods Select 407 patients with gastric carcinoma who were operated upon in the department of abdominal surgery in our hospital from October 2001 to April 2005.The survival rates were analysed with Kaplan-meier and then analysed with univarite and multivariate analysis of cox regression.Results ①In 407 cases,249 died.The median survival time of them was 29 months.over-all survival rate was 71.87%,The 3-year over-all survival rate was 45.33%,The 5-year over-all survival rate was 40.05%.13.27% of them have recurred within half a year,25.21% within one year,46.02% within three years and 51.54% within five years.②Multivariate analysis showed that four major significant factors and affect the prognosis were Borrmann types,radical gastrectomy,time of chemotherapy and TNM staging.Conclusion The reasonable plan of gastrectomy should be drawn up the survival rate of gastric cancer and the synthetic treatment around gastrectomy should be performed basing on biological characteristic of each patient such as TNM clinical stage,Brrrmann type and so on.