胃癌同时合并腹水的临床病理特点及D2根治手术对预后的影响

Correlation analysis of the ascites in gastric cancer and clinicopathologic meaning and the impact of the standard D2 resection on the prognosis

目的分析182例胃癌同时合并腹水患者的临床病理资料,探讨D2根治术对预后的影响。方法回顾性分析我科1994年9月-2009年9月182例胃癌同时合并腹水及胃癌无腹水1 124例的临床病理资料和随访状况。结果胃癌同时合并腹水与卵巢瘤、盆底结节、浸润深度、转移淋巴结、腹膜种植、肝转移、BORRMANN分型、脏器侵犯、CEA〉5μg/L有关,有显著统计学意义（P〈0.01）,而性别、年龄、WHO组织学分型、分化程度与胃癌同时合并腹水无关（P〉0.05）,Logistic回归分析发现盆底结节（P=0.005）、腹膜种植（P=0.000）及脏器侵犯（P=0.000）与胃癌同时合并腹水关系最密切。胃癌同时合并腹水行D2根治术后1、3、5年累积生存率达45%、34%、26%,未行D2根治术1、3、5年的累积生存率只有17%、5%、1%（P=0.000、0.000、0.000）。结论胃癌同时合并腹水是胃癌晚期事件,胃癌同时合并腹水预后比无腹水的患者差;胃癌合并腹水推荐行标准的D2根治术,可改善胃癌同时合并腹水患者的远近期生存率。

Objective To analyse the related clinicopathologic factors in 182 gastric cancer patients with ascites and explore the impact of the standard D2 resection on the prognosis.Methods The clinicopathologic and follow-up data of 182 gastric cancer patients with ascites and 1 124 with no ascites who were operated in our hospital from Sep 1994 to Sep 2009 were reviewed and analyzed retrospectively.Results Pelvic nodular mass,ovary tumor,depth of infiltration,lymph node metastasis,peritoneal implantation metastasis,hepatic metastasis,BORRMANN typing,invasion of neighboring organs and CEA〉5μg/ L were correlated with malignant ascites（P〈0.01）,while sex,age,WHO histological typing and differentiation were incorrelate with malignant ascites（P〉0.05）.Logistic regression analysis showed that pelvic nodular mass,peritoneal implantation metastasis and invasion of neighboring organs were independent risk factors for gastric cancer with ascites respectively（P=0.005,0.000,0.000）.Gastric cancer patients with ascites who took the D2 radical resection had a higher 1,3,5 years survival rate which reached 45%,34%,26%,and the other only reached 17%,5%,1%（P=0.000,0.000,0.000）.Conclusion Ascites in gastric cancer patients is an end stage event and the prognosis is worse than those who have no ascites.We recommend the standard D2 resection in patients with ascites and could improve the survival rate.