胃癌的生物学行为对术式选择的指导意义

Biological behavior of gastric cancer as a guide on operation type

目的 :探讨胃癌的生物学行为特点对术式选择的价值。方法 :1990年 1月～ 2 0 0 0年 1月 ,首次行胃癌切除术病人 2 2 4例 ,其中早期胃癌 2 6例 ,进展期胃癌 198例。随访率 91.5 %。全组均行次全或全胃切除加R1～ 3 淋巴结清扫术。结果 :①生存率比较 :早期胃癌R1与R2 P >0 .0 5。进展期胃癌R1与R2 P <0 .0 1;R1与R3 P <0 .0 1;R2 与R3 P >0 .0 5。②病灶浸润深度与淋巴结转移程度呈正相关 ,两者相辅相成提示病期预后。②肿瘤大小与生存率无统计学意义。④早期胃癌Ⅲ型生长、进展期胃癌浸润型生长预后最差。结论 :胃癌的生物学行为对手术具有指导意义。早期胃癌行次全胃切加R1、选择性R2 淋巴结清扫为宜 ;进展期胃癌宜行距肿瘤 5cm以上的次全或近全胃切加R2 、选择性R3 淋巴结清扫为宜。

Objective: To assess the role of biological Behavior of gastric cancer as a guide on operation type.From Jan.1990 to Jan. 2000,224 cases of gastric cancer were operated in our hospital. All cases were treated with subtotal gastrectomy or near total gastrectomy plus R 1～R 3.Methods: The survival rate was compared according to the operation types: EGC R 1 to R 2 P>0.05;AGC R 1 to R 2 P<0.01, R 1 to R 3 P<0.01, R 2 to R 3 P>0.05. The invasive depth of the lesion was correspond to the degree of lymph node metasteses. No relation was found between tumor size and the survival rate. The prognosis of type III EGC and AGC with infiltrate type was poor. Conclusion: Biological behavior of gastric cancer as a guide on operation type. We proposed that EGC should undergo subtotal gastrectomy plus R 1 or selective R 2,and AGC should undergo subtotal,gastrectomy or near total gastrectomy plus R 2 or selective R 3,with incisal edge at least 5cm to the tumor.