摘要
目的探讨联合脾切除对进展期胃上部癌患者预后的影响。方法1980年1月至2003年6月对237例进展期胃上部癌患者施行了胃癌D2根治术联合脾切除，其中No．10淋巴结转移患者75例，No．10淋巴结无转移患者162例。对影响患者的预后因素进行单因素及多因素分析；对影响患者预后的独立因素进行分层分析。结果237例患者中No．10淋巴结转移和无转移患者术后5年生存率分别为27．7％和35．4％，二者差异有统计学意义（P〈0．05）。单因素分析显示，淋巴结转移、浸润深度、大体分型、胃切除方式和No．10淋巴结转移是影响患者预后的相关因素；其中浸润深度、胃切除方式和No．10淋巴结转移是影响患者预后的独立因素。分层分析显示，T3期No．10淋巴结转移和无转移患者术后5年生存率分别为34．5％和39．7％，二者差异无统计学意义（P〉0．05）；全胃切除No．10淋巴结转移和无转移患者术后5年生存率分别为31．2％和36．7％，二者差异无统计学意义（P〉0．05）。结论对于T3期胃上部癌No．10淋巴结转移的患者，施行全胃联合脾切除能够提高患者远期疗效。
Objective To evaluated the prognostic impact of splenectomy on patients with advanced proximal gastric cancer. Methods The clinical records of 237 patients with advanced proximal gastric cancer who underwent D2 curative resection combined with splenectomy from January 1980 to June 2003 were analyzed retrospectively. Seventy-five patients presented with No. 10 lymph nodes metastasis, while 162 patients did not. Potential patient prognostic factors were evaluated by univariate and multivariate analysis. The independent prognostic factors of patients were performed subgroup analysis. Results The 5-year survival rate was 27.7% for patients with No. 10 lymph nodes metastasis and 35.4% for patients without, the difference was statistically significant between the two groups （ P 〈 0.05 ）. On univariate analysis, lymph node metastasis, macroscopic appearance, depth of invasion, type of gastrectomy and No. 10 lymph nodes metastasis were predictive factors of survival. The depth of invasion, type of gastrectomy and No. 10 lymph nodes metastasis were independent prognostic factors. In the subgroup analysis, the survival rates of T3 patients with and without No. 10 lymph nodes metastasis was 34. 5% and 39.7% , respectively （P 〉0. 05）. For patients undergoing total gastrectomy, survival rates were 31.2% and 36. 7% , respectively （P 〉 0. 05 ）. Conclusions To improve patient prognosis, total gastreetomy with splenectomy should be recommended for patients with T3 proximal gastric cancer with No. 10 lymph node metastasis.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2009年第19期1483-1486,共4页
Chinese Journal of Surgery
关键词
胃肿瘤
淋巴结
脾切除
预后
Stomach neoplasms
Lymph nodes
Splenectomy
Prognosis
