摘要
目的总结和分析残胃癌的治疗方式及预后因素。方法收集2000年3月至2008年5月期间,川北医学院附属第二医院和中国人民解放军总医院收治的共114例残胃癌患者的临床病理学资料,分析其治疗方式及影响预后的因素。结果全组病例手术切除率和R0切除率分别为57.0%(65/114)及54.4%(62/114),行全胃切除、远端胃部分切除、近端胃部分切除、内镜下黏膜切除术(EMR)及内镜下黏膜剥离术(ESD)者分别占手术切除者的73.8%(48/65)、16.9%(11/65)、3.1%(2/65)、4.6%(3/65)及1.5%(1/65),分别占R0切除者的75.8%(47/62)、16.1%(10/62)、3.2%(2/62)、4.8%(3/62)及0。75例获随访,随访时间为0.3～79.0个月,中位随访时间为12个月;总体中位生存时间为19.5个月,1、3及5年累积生存率分别为61.8%、42.3%和30.1%。多因素分析结果显示,首次行远端胃切除(P=0.002)、KPS评分≥80分(P=0.016),大体分型低(P=0.013)和临床无远处转移(P=0.000)者,手术切除率均较高;R0切除(P=0.000)、大体分型(P=0.005)和临床T分期(P=0.006)为残胃癌的独立预后因素。无论是单因素还是多因素分析,原发疾病的良恶性质均不影响预后(P>0.05)。姑息性手术切除、姑息化疗、单纯剖腹手术及最佳支持治疗间的总体生存曲线比较差异无统计学意义(P>0.05)。结论原发疾病的性质不影响残胃癌的治疗及预后,R0切除是残胃癌最重要的独立预后因素;残胃癌的最佳手术方式是切除全部残胃,应尽量避免姑息性剖腹手术。
Objective To summarize and analyze the treatment options and prognostic factors of gastric stump carcinoma（GSC）.Methods The clinical data of 114 patients with GSC treated in The Second Affiliated Hospital of Northern Sichuan Medical College and The General Hospital of Chinese People＇s Liberation Army from Mar.2000 to May. 2008 were reviewed,and influencing factors of surgical resection and prognosis were analyzed.Results For all patients, the ratios of surgical resection and curative resection（R0 resection） were 57.0%（65/114） and 54.4%（62/114）,respectively.The ratios of total gastrectomy,distal gastrectomy,proximal gastrectomy,endoscopic mucosal resection（EMR）, and endoscopic submucosal dissection（ESD） were 73.8%（48/65）,16.9%（11/65）,3.1%（2/65）,4.6%（3/65）,and 1.5%（1/65）in resection cases,and were 75.8%（47/62）,16.1%（10/62）,3.2%（2/62）,4.8%（3/62）,and 0 in R0 resection cases,respectively.Seventy-five patients were followed-up for 0.3-79 months（median 12 months）,the median survival time was 19.5 months,and 1-,3-,and 5-year overall survival rates were 61.8%,42.3%,and 30.1%,respectively.The results of multivariate analysis showed that resection rate was higher in patients with initial distal gastrectomy（P=0.002）,kps score≥80（P=0.016）,lower macroscopic type（P=0.013）,and cM0（P=0.000）.R0 resection（P=0.000）,macroscopic type（P=0.005）,and cT stage（P=0.006） were the independent prognostic factors.There were both no significant difference on survival between the patients with previous benign disease and those with original malignant disease when analyzed with univariate or multivariate method（P0.05）.There were no significant difference on overall survival curve among patients treated with palliative resection,palliative chemotherapy,simple laparotomy,and best supportive care（P0.05）.Conclusion sThe treatment options and prognosis of GSC were not influenced by the primary benign diseases or malignant diseases,and R0 resection is the most important prognostic factor.Removal of total remnant stomach is the best surgical procedure for GSC,and palliative laparotomy should be avoided.
出处
《中国普外基础与临床杂志》
CAS
2012年第12期1307-1318,共12页
Chinese Journal of Bases and Clinics In General Surgery
关键词
残胃癌
手术
预后
Gastric stump carcinoma
Surgery
Prognosis
