胃上部癌全胃切除与近端胃切除的疗效比较

The therapeutic effect of total gastrectomy vs.proximal gastrectomy in superior gastric carcinoma

目的 探讨胃上部癌行根治性全胃切除与近端胃切除的治疗效果。方法 回顾分析本院 1980～ 1994年收治的 2 44例胃上部癌病人 ,通过并发症、生存率等方面对二种术式进行对比。结果 两种术式Ⅰ、Ⅱ期病人 3、5年生存率相似 (P >0 .0 5 ) ,Ⅲ期病人全胃切除组优于近切组 ,3年生存率提高了 2 2 2 % ,P <0 .0 5 ,差异有显著意义。Ⅳ期病人如远处无转移应根据病人状态行全胃加联合脏器切除 ,或姑息性手术。结论 对于胃上部癌的手术 ,应根据病期、肿瘤大小、浆膜受累程度、第 5、6组淋巴结转移情况来选择合理术式。两种术式常见的并发症吻合口狭窄及胆汁返流通过强生吻合器的使用有一定预防作用。

Objective To study the therapeutic effect of total gastrectomy vs.proximal gastrectomy in superior gastric carcinoma.Methods 244 patients with superior gastric carcinoma in our hospital was analyzed retrospectively,and the two operation was compared though the operation type,complication and survival rate.Results The patients of Ⅰ,Ⅱ stage in two groups had a similar 3 year survival rate and 5 year survival rate.The 3 year survival rate of the total gastrectomy group in Ⅲ stage patients,22.2% more,was higher significantly than that of the proximal gastrectomy group.Palliative operation or the total gastrectomy binding with the resection of other organs should be carried in Ⅳ stage patients.Conclusion We should choose the reasonable operation type according to the stage,the dimension,the invation of the serosa,the lymphatic metastasis of the fifth and sixth group lymph nodes.The usage of the anastomotic instrument and the improvement of the operation could prevent the complication,the constriction of the stoma and the bile refluence.