胃癌并幽门梗阻108例TNM分期及临床分析

TNM staging and clinical evaluation for 108 cases suffering from gastric cancer with pyloric obstruction.

目的 探讨胃癌并幽门梗阻时ＴＮＭ 分期的临床特点，以指导诊治及判断预后。方法 按国际抗癌联盟ＴＮＭ 分期及补充规则，对１０８ 例胃癌并幽门梗阻进行临床分析。结果 Ｔ４ Ｎ２ Ｍ１ 病例占６６－６％ ，早、中期胃癌梗阻时间平均１１－４ 天，晚期胃癌梗阻５０－４ 天，差异有非常显著意义（ Ｐ＜ ０－０１） 。上腹扪及肿块４８ 例，其中４７ 例为Ⅳ期，另１ 例为Ⅲｂ 期。结论 胃癌并幽门梗阻绝大部分为癌症晚期。幽门梗阻可能促进胃癌发展，时间越长，越有可能发展至晚期。胃癌并幽门梗阻超过１ 个月，或上腹扪及肿块者，绝大部分为胃癌晚期病人，可作为临床诊断分期指标之一。宜早期手术，解除梗阻。

Objective To investigate the clinical rule,and give better guide to the diagnosis,therapy and judge ment of prognosis for the patients suffering from gastric cancer with pyloric obstruction.Methods We summarized 108 cases suffering from gastric cancer with pyloric obstruction,and studied according to staging TNM for gastric cancer.Results The rate of the cases in T 4N 2M 1 was 66 6%.The time of obstruction on average was 11 4 days in grade Ⅰ、Ⅱ、Ⅲa,and 50 4 days in grade Ⅳ,P<0 01.A mass was felt over upper abdomen in 48 cases,among them 47 patients were in grade Ⅳ and one in grade Ⅲb.Conclusion Pyloric obstruction may promote advance of gastric cancer.The longer the time of obstruction was,the more possible gastric cancer advanced to later period.Most of patients can be grade Ⅳ of gastric cancer if the time of pyloric obstruction is more than one month,or if a mass may be felt over upper abdomen.An operation should be performed as soon as possible so that pyloric obstruction can be relieved.