脾脏切除对胃上中部及全胃癌患者手术疗效的影响研究

Study of influence of splenectomy on surgical efficacy in patients with gastric cancer in upper and middle portion and entire stomach

目的探讨脾脏切除对胃上中部及全胃癌患者手术疗效的影响。方法选取2003年4月至2008年1月于四川省医学科学院/四川省人民医院和浙江大学医学院附属第二医院接受胃癌D2根治术的86例胃上中部及全胃癌患者,将接受保脾改良淋巴结清除术的47例患者作为观察组,接受D2根治术联合脾脏切除的39例患者作为对照组,比较两组患者的远期疗效。结果观察组的住院总时间为(20.62±7.93)d,术后并发症发生率为10.64%,明显少于对照组的住院总时间(27.51±12.44)d和并发症发生率30.77%,两组比较差异有统计学意义(t=3.128,χ2=5.446,P=0.000);观察组与对照组不同TMN分期患者5年生存率比较,差异无统计学意义(P>0.05)。结论对于不伴有脾脏或脾胃韧带转移的胃上中部及全胃癌患者,保留脾脏的改良淋巴结清扫术能够使患者获得与联合脾脏切除相同的预后,并降低了并发症的发生率,值得临床推广。

Objective To study the influence of splenectomy on the surgical efficacy in the patients with gastric cancer in the up- per and middle portion and entire stomach. Methods 86 patients with gastric cancer in the upper and middle portion and entire stomach receiving the gastric cancer D2 radical operation in the two hospitals from April 2003 to January 2008 were selected and di- vided into the observation group（47 cases） and the control group（39 cases）. The observation group accepted the modified lymph- adeneetomy with spleen-preserving,while the control group term effects were compared between the two groups. Results accepted the D2 total radical gastrectomy with splenectomy. The long- The total hospitalization time and the occurrence rate of postoperative complications were（20.62＋7.93）d and 10. 640/00 in the observation group,which were less than （27.51＋12.44）d and 30.77% in the control group, and the differences between the two groups showed the statistical significance（t= 3. 128,X2 = 5. 446, P=0. 000）. The 5-year survival rate in different TNM stages had no statistical difference between the two groups（P^0.05）. Conclusion For the patients with gastric cancer in the upper and middle portion and entire stomach without spleen or splenogastric ligament metas- tasis,the modified spleen-preserving lymphadenectomy could make the patients to get the same prognosis as the gastrectomy com- bined with splenectomy,which reduces the occurrence rate of complications and is worth promoting clinically