晚期胃癌非治愈性手术方式的探讨

Evaluation and rational selection of non-curative operative procedures for advanced gastric carcinoma.

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.