胃癌腹膜转移的临床病理特征及治疗结果分析

The analysis of clinicopathologic characters and survival in gastric cancer with peritoneal metastasis

目的 探讨胃癌腹膜转移的临床病理特点以提供术前诊断的依据 ,并评估手术治疗的结果。方法 回顾性分析 5 7例胃癌腹膜转移病人的临床病理特点和生存情况。结果 5 7例胃癌腹膜转移病人中 ,女性年龄小于男性 (5 0 %vs 2 2 5 8% ,P <0 0 5 ) ,而且其手术切除率明显低于男性 (39 13%vs 6 7 85 % ,P <0 0 5 )。 5 1例手术病人中 ,35 2 9% (18/ 5 1)出现腹水 ,17 6 5 % (9/ 5 1)直肠指检发现肿块。生存分析表明姑息切除病人的生存时间明显长于未切除者 (P <0 0 0 1) ,Cox回归分析显示手术切除是影响预后的唯一因素 (相对危险度0 2 6 1) ,但腹膜转移为P3时手术切除率明显下降 (P <0 0 0 1)。结论 腹水和直肠指检发现肿块是胃癌腹膜转移的常见临床表现 ,其中女性病人年龄偏小且手术切除可能性也较小。如果可能应行姑息切除手术 。

Objective To investigate the clinicopathologic characters for affording the evidences of preoperative diagnoses in gastric cancer with peritoneal metastasis and evaluate the outcome of surgical treatment.Methods A total of 57 gastric cancer patients with peritoneal metastasis were analyzed retrospectively with respect to clinicopathologic characters and survival.Results In contrast with those of male patients,the age of female patients was younger (50% vs 22 58%,P<0 05) and the rate of undergoing palliative gastrectomy was lower(39 13% vs 67 85%,P<0 05).Among 51 patients underwent laparotomy,ascites and rectal lump with anal palpation were found in 18 cases(35 29%) and 9 cases(17 65 %) respectively.Survival times in patients with palliative gastrectomy were obviously longer than those without gastrectomy(P<0 001).Multivariate analysis by Cox regression indicated that gastrectomy was the only significant prognostic factor(relative risk,0 261).But the rate of gastrectomy in P3 patients was remarkably lower(P<0 001).Conclusion The common clinical symptoms in gastric cancer with peritoneal metastasis were ascites and rectal lump with anal palpation.In female patients,the age was younger and the possibility of gastrectomy was minor.Palliative gastrectomy ,if feasible ,is rational.It must be cautious to carry out gastrectomy when peritoneal metastasis is P3.