进展期远端胃癌患者行腹腔镜辅助胃癌根治术后复发的影响因素及治疗

Influential Factors and Treatment of Recurrence of Advanced Distal Gastric Cancer Treated with Laparoscopic-assisted Radical Gastrectomy

目的探讨进展期远端胃癌患者采用腹腔镜辅助胃癌根治术后复发的影响因素及治疗效果。方法回顾性分析90例行胃癌根治术进展期胃癌患者的临床病历资料,根据患者1年内是否复发分组为早期复发组(60例)与无复发组(30例),并采用Logistic回归分析患者术后复发影响因素。将60例术后复发患者分组为甲乙丙3组,各20例,分别采用再次手术、姑息治疗及未手术治疗,统计3组患者生存时间。结果经单因素分析发现,患者早期复发影响因素为瘤体直径和TNM分期、T分期、N分期、术后化疗、新辅助化疗及Borrmann分型、Lauren分型,P<0.05;经多因素分析,患者术后复发高危因素为N分期与TNM分期,且新辅助化疗为患者术后保护因素,P<0.05。经再次治疗发现,其中甲组3年生存率明显高于乙、丙组,P<0.05,而乙组略高于丙组,P>0.05。结论进展期胃癌根治术后早期复发高危因素主要为N分期与TNM分期,积极采取新辅助化疗及腹腔镜辅助胃癌根治术治疗,可以减少复发,延长患者生存期。

Objective To explore the clinical efficacy of advanced distal gastric cancer treated with laparoscopic-assisted radical gastrectomy. Methods A retrospective analysis of 90 advanced gastric cancer patients treated with routine radical gastrec-tomy was conducted, according to whether the patients relapsed within 1 year, patients were divided into early relapse packet group （60 cases） and non-recurrent group （30 cases）, and logistic regression analyzed factors affecting relapse patients ,60 cases of patients were grouped into three groups B and C, each with 20 cases, respectively received reoperation, palliative care and non-surgi- cal treatment,the survival time of the 3 groups of patients were analyzed. Results Univariate analysis showed that patients with early relapse factors affecting tumor diameter and TNM stage, T stage, N stage, postoperative chemotherapy, neoadjuvant chemo- therapy and Borrmann type, Lauren classification, P 〈 0.05 ; muhivariate analysis, patients with risk factors for recurrence of N staging and TNM staging, neoadjuvant chemotherapy and protective factors for postoperative patients,P 〈 0.05. After treatment was found again, where Group A 3-year survival rate was significantly higher than B, Group C, P 〈 0.05, slightly higher than the Group C and Group B,P 〉 0.05. Conclusion Risk factors of early recurrence of gastric cancer are mainly N staging and TNM stage, and therefore need to actively take neoadjuvant chemotherapy and radical surgery treatment, which can help reduce recurrence and prolong survival.