胃癌根治术全胃切除适应证分析

The indication of total gastrectomy in radical resection for carcinoma of stomach

目的探讨进展期胃癌根治术中全胃切除合理适应证的影响因素。方法选取哈尔滨医科大学附属肿瘤医院1997年1月-2007年12月期间随访完整的609例胃癌根治术病人，其中全胃切除患者273例，保胃组患者336例，分别定义全胃切除组和保胃组，比较保胃组和全胃切除组的生存差异，分析患者的基本情况、肿瘤部位、分化程度、Borrmann分型、肿块大小、淋巴结转移以及切缘距肿瘤距离因素。结果保胃组生存期明显优于全胃切除组（x。=5．183，P〈0．05）。患者术前Kamofsky、ECOG评分中，保胃组患者明显优于全胃切除组，但Goldman评分全胃切除组较好（P〈0．05）。全胃切除组多为肿块较大、浸润范围广、淋巴结转移多、肿瘤位于胃近端的患者，与保胃组相比差异具有统计学意义（P〈0．01），同时全胃切除与切缘距肿瘤的距离以及分化程度密也具有相关性（P〈O．05）。结论全胃切除并不能延长胃癌患者生存期。肿块较大、肿块呈浸润性生长、肿瘤位于近端、淋巴结转移多是胃癌根治术中行全胃切除的决定因素，肿瘤的切缘距离和分化程度为全胃切除的影响因素，同时患者全胃切除时应考虑其体力、营养状况、心肺功能和疾病严重程度。

Objective To investigate the influencing factors for indication of total gastrectomy in radical resection for carcinoma of stomach. Methods 609 patients from the Tumor Hospital of Harbin Medical University with radical resection for carcinoma of stomach were studied and classified into the total gastrectomy group,which were 273 after total gastrectomy and the partial resection group which were 336 after partial resection. The data were compared between two groups such as tumor position, tumor size, Borrmann, differentiation type, distance from cutting edge to tumor and lymph node metastasis. Results The survival time of the partial resection group was obviously longer than the total gastrectomy group（ ~2 = 5. 183 ,P 〈0.05）. The preoperative data of partial re- section group was better than total gastrectomy group in Kamofsky and ECOG,while total gastrectomy group better in Goldman（ P 〈0.05）. There were significant differences of the size of tumor,lymph node metastasis and the ar- eas of infiltration between two groups（ P 〈 0.01 ）. The total gastrectomy group was associated with the distance from cutting edge to tumor and differentiation type（ P 〈 0.05）. Conclusion The total gastrectomy can＇t guarantee a prolonged survival. The determinative factors of total gastrectomy included big lump,lymph node metastasis and a- broad areas of infihration,ect. Nutriture and cardiorespiratory function were important in total gastrectomy.