胃上部癌根治术中保留脾脏与复发及转移和预后的相关性研究

Relative research of the recurrence and metastasis and prognosis of the patients with the radical excision of upper gastric cancer with preserving of the spleen

目的:探讨胃上部癌根治术中保留脾脏与患者复发及转移和预后的相关性。方法:回顾性分析施行根治性手术的127例胃上部癌患者的临床病理资料,比较切脾组和保脾组术后并发症发生率、肿瘤复发及转移、术后生存及预后情况。结果:25例(19.7%)联合脾或脾、胰体尾切除术(切脾组),102例(80.3%)未行脾切除术(保脾组),2组患者在年龄、性别、肿瘤大小、Borrmann分型、组织学分化程度、淋巴结转移和TNM分期方面差异无统计学意义(P>0.05)。切脾组并发症发生率为12.0%(3/25),保脾组并发症发生率为8.8%(9/102),2组比较差异无统计学意义(P>0.05)。切脾组术后复发及转移仅1例(4%),为肝转移;而保脾组术后复发及转移6例(5.9%),其中腹腔内种植转移致大量腹水3例,肝转移1例,吻合口复发1例,腹腔内淋巴结转移1例。2组复发及转移率比较,差异无统计学意义(P>0.05)。切脾组患者5年存活率为18.2%,而保脾组为41.7%,组比较差异有统计学意义(P<0.01)。结论:切2脾与否对患者术后并发症发生率和肿瘤复发及转移无明显影响,但保留脾脏能延长患者术后的5年存活率。

Objective：To analyze the influence of radical excision with preserving of the spleen on recurrence,metastasis and prognosis of the patients with upper gastric cancer.Methods：The clinical pathological data of 127 cases of the radical excision for upper gastric cancer from January 1992 to December 2005 were analyzed retrospectively,for comprising complication rate,recurrenceand metastasis of the cancer and the postoperative survival and prognosis of radical excision com bining splenectomy and preserving the spleen.Results：Radical excision combining splenectomy for upper gastric cancer was performed in 25 cases（19.7%）.102 cases（80.3%）were selected with preserved spleen.There was not significantly difference between the two groups in sex,age,tumor size,location,Borrmann type,range of lymph node dissection and TNM stage（P0.05）.The compli cation rate of the radical gastrectomy only was 12.0%（3/25）,wheras the radical gastrectomy com bining splenectomy for gastric cancer was 8.8%（9/102）.The complication rate between the two groups was not significantly different（P0.05）.The recurrence of splenectomy group had one case（4%）,with liver metastasis;wheras the preserving spleen group had 6 cases（5.9%）.Among them,the patients with massive ascites resulted from abdominal cultivation,liver metastasis,anastomotic recurrence and abdominal lymph node recurrence were 3 cases,1 case,1 case,1 case respectively.The recurrence rate between the two groups was not significantly different（P0.05）.It was significantly different between the group in 5-year survival rate（P0.01）,which was 18.2% in the splenectomy group,wheras in the preserving spleen group was 41.7%.Conclusions：There are no significantly influence on the the postopretive patients in complication rate and tumor recurrence and metastasis,whether combining splenectomy or not.However,preserving spleen can increase the 5-year survival rate.