摘要
目的 为晚期胃癌合理选择非治愈性手术方式提供依据。方法 按病情程度、生物学行为分组 ,评价5 78例行非治愈性手术的Ⅲb、Ⅳ期胃癌病例手术后效果。结果 姑息切除、改道及探查手术三组间 ,手术越大并发症越多 (P <0 0 5 ) ,手术死亡率差别不大 (P >0 0 5 )。术后 2年生存率姑息切除明显优于改道和探查组 (P<0 0 5 )。无腹膜、肝脏及远处转移组及有腹腔转移、无肝转移组姑息切除术后各年生存率差异均无显著意义 (P>0 0 5 ) ,有肝转移组术后生存率降低 ,随肝转移程度愈趋明显 (P <0 0 5 )。姑息切除术后 2年生存率 ,限局型明显优于浸润型 (2 0 0 %比 9 5 % ,P <0 0 5 )。远端、近端及全胃姑息切除术后生存率差异无意义 (P >0 0 5 )。结论 姑息切除效果优于不切除。腹膜转移不影响姑息切除术后生存率 ,肝转移手术效果不良 ,H3 者切除意义不大 ,限局型胃癌应优先考虑切除。
Objective To provide basis for rationally selecting non-curative operative procedures for patients with terminal stage gastric carcinoma.Methods In accordance with condition level and biologic behavior of gastric carcinoma the effect of non-curative procedure in 578 cases of TNM stage Ⅲb and Ⅳ gastric carcinoma was evaluated.Results Among palliative resections,exploratory laparotomies, by-pass procedures, the postoperative complications increased as the procedures became complex(P<0.05).no significant difference in operative mortality(P>0.05).The two-year postoperative survival rate in pallitive resection was the highest (P<0.05).The postoperative survival rate was not significantly different between group without PH(peritontal and hepatic metastases) and group P without H(P>0.05),it declined in group H(P<0.05).There were no significant mortality difference among procedures of distal,proximal partial and total gastrectomy(P>0.05).Conclusion The effect of palliative resection was better than that of non-resections.The effect of palliative resection was not interfered with peritoneal dissemination, but with liver metastasis.H 3 was not feasible for palliative resection.Patients with gross expanding pattern have longer survival time.Palliative total and proximal partial gastrectomies have similar effect with distal partial gastrectomy.
出处
《中国实用外科杂志》
CSCD
北大核心
2000年第10期605-607,共3页
Chinese Journal of Practical Surgery