摘要
目的了解不同区域腹膜种植胃癌临床病理特征及手术治疗对预后的影响。方法中山大学附属第一医院1994年8月至2006年3月共收治107例胃癌伴单纯腹膜种植,分析其临床病理参数并评估外科治疗对预后的影响。依种植区域分为结肠上区(SC)、结肠下区(IC)、全腹膜种植(TPS)3组。结果TPS组的年龄较单区域种植组小(P<0.05),SC和TPS组发生脏器侵犯的比例高于IC组(P<0.05)。病灶全切除、病灶姑息性切除较旁路或造口手术、探查活检术的存活期明显延长(P<0.05),手术方式为独立预后因素。淋巴结清扫组较未清扫组的存活期显著延长(P<0.01)。全胃切除(TG)、部分胃切除(PG)较未切胃(NG)的存活期明显延长(P<0.05)。结论低龄胃癌病人容易发生远处腹膜种植,结肠上区和全腹腔种植者易发生局部脏器浸润,病灶全切除和姑息性切除、适度淋巴清扫可提高病人存活期,在满足病灶切除条件下,应首选部分胃切除而不是全胃切除。
Objective To analyze the elinicopathological features of gastric tauter （GC） with implantation metastasis of different location,and asses the surgical intervention impacting on the prognosis. Methods According the implantating districts, 107 cases of gastric cancer with implantation metastasis admitted betweeu August 1994 and March 2006 were divided into supracnlic compartment （ SC ） , infracolic compartment （ IC ） and total peritoneal seeding （TPS） group. The clinical patho-parameters were analyzed,and the influences of various surgical strategies on prognosis were assessed. Results In 3 groups,there had no significant difference in gender,location of tumor,tumor size,serosal infihration,organie encroachment,distance of lymphatic metastasis, Borrmann typing, tissue typing, differentiated degree （ P 〉 0.05 ）. The age of TPS group was significant younger than in SC and IC groups （ P 〈 0.05 ）. The rate of organic infihration in SC and TPS groups was significant higher than in IC （ P 〈0. 05）. The mean survival time （months） in group of total fi）cal resection （ TFR ）, palliative focal resection （ PFR ）, feeding neostomy or by-pass operation （ FN ）, exploratory laparotomy （ EL ） was 48.7,13.9,10. 1,3.7 respectively. TPR and PFR extended survival time significantly than FN and EL （ P 〈 0.05 ）. COX regression showed that modus operandi was an independent prognostic factor. The mean survival time（months） in group of lymph node dissection （LD） and no lymph node dissection （NLD） was 48.7,11.8 respectively, with significant difference （ P 〈 0. 01 ）. The mean survival time （months） in group of total gastrectomy （ TG）, partial gastrectomy （ PG）, no gastrectomy（NG） was 34. 4,34. 1,4. 9 respectively. Comparing with NG,TG and PG significantly extended life span （ P 〈 0. 05 ） , but no significant difference between group of TG and PG （ P 〉 0.05 ）. Conclusion Younger patients with gastric cancer are easy to suffer implantation metastasis. Implantation of SC and TPS frequently follow with local organic infiltration. TFR and PFR, LD,TG and PG can extend lile span of GC with implantation metastasis. Under the condition of satisfactory focus resection,PG is the preferred strategy,not TG.
出处
《中国实用外科杂志》
CSCD
北大核心
2007年第11期879-882,共4页
Chinese Journal of Practical Surgery
关键词
胃癌
腹膜种植转移
淋巴结清扫
gastric cancer
peritoneal implantation metastasis：lymph node dissection
