进展期胃癌淋巴结转移与全胃联合脾胰体尾切除的相关性

Correlation between lymph node metastasis and total gastrectomy combined with pancreaticosplenic resection for advanced gastric cancer

目的:探讨进展期胃癌根治术的全胃切除联合脾胰体尾切除合理适应证与淋巴结转移等的相关性。方法:选取我院自1997年1月至2007年12月期间273例行全胃切除的胃癌根治术病人,比较全胃联合脾胰体尾切除组(切脾组)和单纯全胃切除(保脾组)之间在肿块大小、淋巴结转移、生长方式、Borrmann分型、癌灶距脾门距离、分化类型以及生存期等方面的差异。结果:切脾组病人5年生存率为31.8%,保脾组为35.4%,两组在5年生存率上无统计学差异(χ2=0.205,P>0.05),在生存曲线上两组间有统计学差异,保脾组明显优于切脾组(χ2=10.853,P<0.01)。切脾组和保脾组间4、10、11组淋巴结转移情况、肿块大小、分化程度、生长方式、Borrmann分型等方面差异有统计学意义(P<0.01)。第4组淋巴结有转移与第10、11组淋巴结有转移的病人相关性比较无统计学差异(P>0.05),但是第10、11组淋巴结有转移的12例病人中有11例第4组淋巴结转移。结论:胃癌根治术全胃切除时,肿块较大、分化较差、呈浸润性生长并4、10和11组淋巴结有转移应考虑联合脾胰体尾切除,但全胃联合脾胰体尾切除不一定延长胃癌病人生存期。

Objective To investigate the correlation of lymph node metastasis with total gastrectomy combined with pancreaticosplenic resection for advanced gastric cancer. Methods During Jan 1997 to Dec 2007 273 patients with total gastrectomy were studied and classified into total gastrectomy combined with pancreatieosplenic resection group （TGPR） and without pancreaticosplenie resection group（TG）. The data of tumor size, lymph node metastasis, growth pattern, Borrmann classification, distance from tumor to hilum of spleen, differentiation type and survival time were compared between two groups. Results 5-year survival rates of TGPR and TG were 31.8% and 35.4% respectively. There was no significant difference ~=0.650 4, P〉0.05）. There was significant difference of survival curve between two groups with TG better than TGPR ff2=10.863, P〈0.01）. There were significant differences between two groups in rate of lymph node metastasis for No.4, No.10 and No.l l, tumor size, differentiation, growth pattern and Borrmann classification （P〈0.01）. There was no significant correlation between patients with lymph node metastasis for No.4 and patients with lymph node metastasis for No. 10 and No.11 （P〉0.05）. There were 11 out of 12 patients with lymph node metastasis for No. 10 and No.11 who were accompanied with lymph node metastasis for No.4. Conclusions Gastric cancer with bigger lump, poorer differentiation, invasion into hilum of spleen and lymph node metastasis for No.4, No.10 and No.ll were indications of total gastrectomy combined with pancreaticosplenic resection. But total gastrectomy combined with pancreaticosplenic resection does not necessarily prolong survival time.