不同术式对进展期近端胃癌185例预后分析

Prognosis Analysis by Different Surgical Methods on 185 Cases of Advanced Proximal Gastric Cancer

目的:探讨不同术式对进展期近端胃癌预后影响。方法:选择2003年2月～2008年8月本院收治的进展期近端胃癌185例手术患者作为研究对象,分别采用全胃切除术和近端胃切除术,并分析术中情况、术后并发症及生存率。结果:两组不同术式在手术时间、术中出血量、平均住院日方面比较,差异均无统计学意义(P>0.05);反流性食管炎、进食后饱胀感、吻合口狭窄及残胃无张力并发症全胃切除术组发生率明显低于近端胃切除组,差异有统计学意义(P<0.01,或P<0.05);两种不同术式术后1年生存率分别为80.95%、75.96%,两组比较差异无统计学意义(P>0.05);3、5年随访生存率全胃切除组分别为60.32%、36.5l%,明显优于近端胃切除组的41.35%、20.19%,两组比较差异有统计学意义(P<0.05)。结论:进展期近端胃癌采用根治性全胃切除术更为合适。

Objective：To probe into prognosis affect on advanced proximal gastric cancer by different surgical methods.Methods：Choose 185 patients who suffered from advanced proximal gastric cancer received and cured by our hospital from February 2003 to August 2008 as the study object and adopt respectively total gastrectomy and proximal gastrectomy as well as making analysis on the intraoperative situation,postoperative complications and survival rate.Results：The difference of operation duration,intraoperative cadaverine quantity of bleeding,average hospitalization period of two group of different surgical methods had no statistics significance （P〉0.05）;in the aspect of the incidence of reflux esophagitis,feeling of repletion atter having meals,narrow anastomotie stoma and complications of atonia gastric remnant,the total gastrectomy group was remarkably lower than the proximal gastrectomy group and the difference had statistics significance（P〈0.0 l,~：~P〈0.05）;the survival rate of the two different surgical methods after one year were 80.95% and 75.96% respectively and the difference between the two groups had no statistics significance （P〉0.05）;in the follow-up visit after 3 or 5 years, the survival rate of total gastrectomy group were 60.32% and 36.5 l%,which were remarkably superior to that of proximal gaslrectomy group （41.35% and 20.19%） and the differences between the two groups had statistics signiticance（P〈0.05）.Conclusion：It was more appropriate to adopt radical total gastrectomy for advanced proximal gastric cancer.