摘要
目的 比较进展期近端胃癌行近端胃切除与全胃切除的临床效果和预后. 方法 行根治性切除手术的进展期近端胃癌221例,其中82例行近端胃切除术,139例行全胃切除术,比较两组患者的淋巴结切除数目、术后并发症发生率和死亡率,用Kaplan-Meier方法计算生存率,并对两组患者的生存率进行Log-rank检验.结果 82例近端胃切除手术标本巾共检出淋巴结1411枚（11 ～34枚/例）,平均（17±11）枚/例,139例全胃切除手术标本巾共检出淋巴结3 345枚（14 ～ 35枚/例）,平均（24±10）枚/例,近端胃切除淋巴结清扫数目少于全胃切除淋巴结清扫数目（￡=2.586,P＜0.05）;近端胃切除组总体并发症发生率高于全胃切除组（73.2％比30.2％,x2=38.291,P＜0.01）;近端胃切除术后并发胃排空障碍、吻合口瘘、吻合口狭窄、反流性食管炎多于全胃切除术组（P＜0.01）;近端胃切除术后患者的总体生存率低于全胃切除术患者（P＜0.01）. 结论 对进展期近端胃癌宜行全胃切除术.
Objective To investigate the clinical results and prognosis between proximal and total gastrectomy in proximal advanced gastric cancer.Methods The clinicopathological data of 221 patients with proximal advanced gastric cancer who undcrwent radical gastrectomy were retrospectively analyzed.82 patients and 139 patients underwent proximal and total gastrectomy respectively.The number of dessected lymph nodes,postoperative complications and mortality were compared.Kaplan-Meier survival rate curves and Log-rank test were drawn and compared.Results A total of 1 411 （11-34） and 3 345 （14-35） lymph nodes were harvested from the surgical specimens of 82 and 139 patients with proximal and total gastrectomy respectively,the average number of harvested lymph nodes was 17 ± 11 and 24 ± 10 （t =2.586,P 〈0.05）.The overall complications in proximal gastrectomy were higher than total gastrectomy （73.2% vs.30.2%,x2 =38.291,P 〈0.01）.The ratio of functional delayed gastric emptying,anastomotic leakage and stenosis,reflux esophagitis in proximal gastrectomy patients was higher than total gastrectomy.The survival rate in proximal gastrectomy were lower than total gastrectomy in proximal advanced gastric cancer （P 〈0.01）.Conclusion Total gastrectomy is recommended for proximal advanced gastric cancer.
出处
《中华普通外科杂志》
CSCD
北大核心
2016年第2期97-99,共3页
Chinese Journal of General Surgery
关键词
胃肿瘤
胃切除术
淋巴结切除术
Stomach neoplasm
Gastrectomy
Lymph nodes excision
