胃癌联合脾胰体尾切除术的适应证及远期疗效

Indications and Late Results of Gastric Cancer Resection Combined with Pancreaticosplenectomy

研究胃癌联合脾胰体尾切除术的适应证及远期疗效。方法：观察35例胃癌的大小、大体类型、生长方式、浆膜浸润程度、肿块至脾门的最近距离、4s、4d组淋巴结转移及其与脾门淋巴结转移的关系。并对50例胃癌病人联合脾胰体尾切除病例5年生存率与未行脾胰体尾切除的病例进行比较。结果：肿块距脾门最近距离≤5.0cm并呈浸润生长时，与脾门淋巴结转移呈极显著相关(P<0.01)，4s组淋巴结疑有转移癌或冰冻证实有癌转移时与脾门淋巴结呈显著相关(P<0.05)，胃癌联合脾胰体尾切除与非联合脾胰体尾切除根治术后，比较5年生存率无显著差异(P<0.05)。结论：肿块边缘距脾门的最近距离≤5.0cm、4s组淋巴结疑有转移或冰冻证实有癌转移、肿块呈浸润性生长并接近脾门时，脾门淋巴结极有可能转移，至少应行胃癌联合脾胰体尾切除手术，同时胃癌联合脾胰体尾切除手术并未降低胃癌术后的5年生存率，因此，可以将胃癌联合脾胰体尾切除手术的指征再进一步放宽。

To study the indications and late results of gastric cancer resection combined with pancreaticosplenectomy. Methods: Fifty cases of radical gastrectomy combined with resection of the body/tail of pancreas together with splenectomy were compared to cases of radical gastrectomy without pancreaticosplenectomy. Results: Lymph nodes of the splenic hilum were most likely to be involved in the following conditions: ①tumors belonging to the infiltrative type, with a distance between the tumor margin and the splenic hilum≤5.0cm(P<0.01); ②4s nodes proven to be positive by frozen section or highly suspected to be metastatic(P<0.05). Pancreatico-splenectomy did not affect significantly the rate of infection and its 5-year survival rate was comparable to other radical operations. Conclusions: Radical gastrectomy combined with pancreaticosplenectomy should be performed according to the indications outlined in this paper.