摘要
目的探讨胃癌根治手术联合脾脏切除对胃癌患者预后的影响。方法1994年6月至2004年3月完成胃癌手术692例,其中在胃癌D2、D3手术基础上联合脾脏切除45例,选择同时期完成的具有可比性的仅行胃癌根治手术的343例病例进行分析,比较淋巴结转移的临床病理学因素、淋巴结转移率、切除脾脏后5年生存率。结果胃癌联合脾脏切除No10淋巴结转移率为15.6%,其中上1/3(U)区为11.5%,中1/3(M)区为33.3%,下1/3(L)区为0%。近端胃癌和胃体部癌、低分化及未分化腺癌、Borrm annⅢ、Ⅳ型、肿瘤浸润深度在T3、T4以及Ⅲ、Ⅳ期胃癌与远端胃癌、高中分化腺癌、Borrm annⅠ、Ⅱ型、肿瘤浸润深达度在T1、T2以及Ⅰ、Ⅱ期胃癌比较,其淋巴结转移率的差异有统计学意义。Ⅰ、Ⅱ期胃癌切除脾脏后平均生存时间和中位生存时间与单纯胃癌根治手术组比较降低并有统计学意义差异,Ⅲ、Ⅳ期胃癌切除脾脏以后平均生存时间和中位生存时间与单纯胃癌根治手术组比较差异无统计学意义。结论Ⅰ、Ⅱ期胃癌患者不应联合脾脏切除,Ⅲ、Ⅳ期胃癌联合切除脾脏也未能提高术后生存率,胃癌直接侵犯胰腺体尾部,脾门淋巴结明显肿大转移者,才有脾切除的指征。联合脾脏切除的手术适应证需进一步研究。
Objective To analyze the influence of radical excision combining splenectomy on prognosis of the patients with gastric cancer. Methods Between June 1994 and March 2004, 692 patients were operated on for gastric cancer and registered into gastric cancer database. Radical excision （ D2, D3 or D4） combining splenectomy for gastric cancer was performed in 45 cases. 343 cases were selected simultaneously for comparison according to the resembling rules in sex, age, tumor size, location, serosa invasion, Borrmann type and range of lymph node dissection. Clinicopathological factors affecting lymph node metastasis, patterns of lymph node metastasis, 5-year survival rate after radical excision combined with splenectomy for gastric cancer were compared. Results Lymph node metastasis rate of splenic hilus was 15.6 percents. Among them, upper, middle and lower domain is 11.5 percent, 33.3 percent and zero respectively. It was significantly different between gastric adenocarcinoma in proximal and body of stomach and that in distal stomach, poor differentiation and adenocarcinoma anaplastic and well and moderately differentiation adenocarcinoma, Borrmann Ⅲ and Ⅳ types and Borrmann Ⅰ and Ⅱ types, infiltrated depth in T3 and T4 and infiltrated depth in T1 and T2, clinical stages Ⅲ and Ⅳ and clinical stages Ⅰ and Ⅱ. The average and median survival time between radical gastrectomy only and radical gastrectomy combining splenectomy for gastric cancer at stage Ⅰ and Ⅱ patients were significantly different, but at stage Ⅲ and Ⅳ patients not significantly different. Conclusions Spleen should be reserved for patients with gastric cancer at stage Ⅰ and Ⅱ , and radical excision combining splenectomy could only be performed at stage Ⅲ and Ⅳ patients with cancer infiltrating body and tail of the pancreas, or lymph nodes metastasis in the splenic hilus. Indication of radical excision combining splenectomy for gastric cancer must be further study to clarify its efficacy.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2005年第17期1114-1117,共4页
Chinese Journal of Surgery
