不同手术方式治疗弥漫型近端进展期胃癌患者的近期疗效及远期预后

Short-term Efficacy and Long-term Prognosis of Patients with Diffuse Proximal Advanced Gastric Cancer Treated with Different Surgical Methods

【目的】探讨不同手术方式治疗弥漫型近端进展期胃癌（AGC）患者的近期疗效及远期预后。【方法】本院诊治的弥漫型近端AGC患者80例,随机分为两组,各40例;观察组实施全胃切除术,对照组进行近端胃切除术（部分切除）。术后随访3年,比较两组手术及术后早期恢复情况,对比两组手术前后血红蛋白（Hb）、白蛋白（Alb）、总蛋白（TP）,并分析两组术后生存及复发情况。【结果】观察组手术时间、术中出血量均低于对照组（P〈0.05）,而淋巴结清扫个数较对照组明显增加（P〈0.05）;两组术后1年血浆Hb、Alb、TP均较术前降低（P〈0.05）,但组间比较差异无显著性（P〉0.05）;观察组术后3年生存率为53.33%（24/40）、无瘤生存率为46.67%（21/40）,分别较对照组的31.11%（14/40）、22.22%（10/40）高（P〈0.05）,而复发率组间比较无显著差异（P〉0.05）;观察组术后3年内并发症发生率明显低于对照组（P〈0.05）。【结论】全胃切除术治疗弥漫性近端AGC近期肿瘤学效果好,在缩短手术时间、减少术中出血量同时,增加了淋巴结清扫数目,3年生存率、无瘤生存率明显提高,值得临床推广应用。

【Objective】To investigate the short-term efficacy and long-term prognosis of different surgical methods for treating diffuse proximal advanced gastric cancer （AGC）.【Methods】A total of 80 patients with diffuse proximal AGC treated in our hospital from February 2011 to April 2014 were enrolled in the study. They were randomly divided into two groups by random number table method, with 40 cases in each group. The observation group （A group） was treated with total gastrectomy, while the control group （B group） was treated with proximal gastrectomy （partial resection）. All patients were followed up for 3 years after surgery. The general data, early recovery after surgery, hemoglobin （Hb）, albumin （Alb）, total protein （TP）, 3-year survival rates, tumor-free survival rates and recurrence rates were compared between the two groups.【Results】The surgical time was shorter and intraoperative blood loss was less in the A group compared to those of the B group （P〈0.05）, while the number of dissected lymph nodes was significantly more than that in the B group （P〈0.05）. Levels of plasma Hb, Alb and TP one year after surgery in both groups were decreased （P〈0.05）, but there was no significant difference between the two groups （P〉0.05）. The 3-year survival rate （53.33%） and tumor-free survival rate （46.67%） of the A group were higher than those of the B group （31.11% and 22.22%, respectively;P〈0.05）, while there was no significant difference in recurrence rate between the two groups （P〉0.05）. The incidence of complications in the A group within 3 years after surgery was significantly lower than that in the B group （P〈0.05）.【Conclusion】The short-term efficacy of total gastrectomy is a good way to treat diffuse proximal AGC. It can shorten the surgical time, reduce intraoperative blood loss, increase the number of dissected lymph nodes, and significantly improve the 3-year survival rate and tumor-free survival rate of patients.