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目的 :对贲门胃底癌两种不同手术方式远期疗效进行对比分析。方法 :全胃切除 2 4例 ,近端胃大部分切除 2 8例 ,并从淋巴转移、肿瘤大小、浆膜受累、术后并发症、生存期等比较两者疗效。结果 :全胃组和近切组 3、5年总生存率为 41.6 7%、2 0 .83%和 39.2 9%、 10 .71% ,两者相比 ,3年生存率的差异无显著性 (P >0 .0 5 ) ,而 5年生存率具有显著差异性 (P <0 .0 5 )。淋巴结阳性病例中 ,5年生存率全胃组和近切组分别为 11.11%和 4.76 % ,差异具有显著性 (P <0 .0 5 ) ;无淋巴结转移的贲门胃底癌行全胃切除和近端胃大部分切除 ,两者无显著差异。全胃组和近切组术后并发症分别为 37.5 %和 2 1.43% ,差异性具有显著性 (P <0 .0 5 )。结论 :淋巴结阳性者积极行全胃切除对预后有较好的效果 ,但全胃切除可能增加术后并发症。
Objective: To compare the long-term curative effect of two different operation methods of cardia gastric fundus cancer. Methods: Totally 24 cases of total gastrectomy and 28 cases of proximal gastric resection were performed. The curative effect was compared between the two groups in terms of lymph node metastasis, tumor size, serosa involvement, postoperative complications and survival. Results: The 3-year and 5-year overall survival rate was 41.6 7%, 20.83% and 39.2 9%, 10.71% respectively in the whole stomach group and the near resection group. There was no significant difference in the 3-year survival rates between the two groups (P> 0.05), but the 5-year survival rate was significantly different (P <0.05). In the positive lymph node cases, the 5-year survival rate was 11.11% in the whole stomach group and 4.76% in the proximal group, the difference was statistically significant (P <0.05). The total gastric gastrectomy was performed in patients with gastric cardia fundus without lymph node metastasis Most of the proximal stomach resection, no significant difference between the two. The rates of postoperative complications were 37.5% and 2.143% in the whole stomach group and the proximal group, respectively, with significant differences (P <0.05). Conclusions: Positive gastrectomy in patients with positive lymph nodes has good prognosis, but total gastrectomy may increase postoperative complications.