常见单个脏器浸润胃癌的临床分析

Clinicopathological features, surgical procedures and prognosis of gastric cancer patients with singleorgan invasion

目的比较常见单个脏器浸润胃癌患者的临床病理特征、手术治疗及预后。方法从单个脏器浸润胃癌患者中筛选出列于前4位者，共228例，分别为胰腺（83例）、横结肠及系膜（71例）、食管（53例）、十二指肠（21例）浸润组，比较各组的临床病理特征、手术治疗及预后。结果各组病例中，食管浸润组的远处转移率、腹膜种植率、pTNM1V期所占比例均最低，分别为9％、8％、34％，差异均有统计学意义（均P〈0．05）。各组之间淋巴结N分期、肝转移率、肿瘤Borrmann分型、WHO组织分型、分化程度、血清CEA等相比差异均无统计学意义（均P〉0．05）。各组之间相比，食管浸润组的根治率最高，为93％；胰腺浸润组接受扩大淋巴结清扫术（D2以上）比例最高，为25％，组间比较差异均有统计学意义（均P〈0．05）。胰腺浸润组的中位输血量为400ml，高于其他各组，差异有统计学意义（P〈0．05）。各组手术时间、淋巴结清扫数目、术后并发症之间相比差异均无统计学意义（均P〉0．05）。单因素分析表明脏器浸润为胃癌患者预后影响因素。胰腺、横结肠及系膜、食管、十二指肠浸润组的中位生存期分别为15．4、17．5、30．9、14．1个月，根治性切除患者的各组中位生存期分别为23．8、19．7、35．8、17．4个月，食管浸润组预后均最好，差异均有统计学意义（均P〈0．05）。非根治性手术者的各组预后之间相比差异均无统计学意义（均P〉0．05）。结论对常见单个脏器浸润胃癌，食管浸润患者的分期较早，根治率高，预后较好；根治性切除对改善常见单个脏器浸润胃癌患者的预后有益。

Objective To invastigate the clinicopathological features, surgical procedures, prognosis of gastric cancer cases with single organ invasion. Method According to morbility, in an order from high to low, 288 cases of gastric cancer with single organ invasion, were divided into group of pancreas （ n = 83 ） , transverse colon or mesocolon（ n = 71 ） , esophagus（ n = 53 ） , and duodenum invasion（ n = 21 ）. Clinicopathological features, surgical procedures and prognosis were compared among groups. Results In group of esophagus invasion, the ratio of distal metastasis, peritoneal metastasis, pTNM stage was 9% ,8%, 34% respectively, all was the lowest among all groups（ all P 〈 0. 05 ）. The ratio of cases receiving radical resection in esophagus invasion group was 93% （ P 〈 0. 05 ）, whereas, the ratio of patients receiving extended lymphadenectomy was 25% in pancreas invasion group （ all P 〈 0. 05 ）. Univariate survival analysis showed organ invasion was the prognostic factor. The median survival time was 15.4, 17.5, 30. 9, 14. 1 months in group of pancreas, transverse colon or mesocolon, esophagus, duodenum invasion respectively, and in cases who received radical resection, it was 23.8, 19.7, 35.8, 17.4 months respectively, all with significant difference （all P 〈 0. 05 ）. Among groups, the prognosis was not significantly different in those receiving palliative resection （ P 〉 0.05 ）. Conclusions Compared with other adjoining single organ invasion, gastric cancer patients with esophagus invasion are often with earlier TNM stage, higher ratio of radical resection and better prognosis. Radical resection improves the prognosis of gastric cancer patients with single organ invasion.