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目的探讨经腹根治性全胃切除术治疗贲门癌患者的效果并分析影响其预后的因素。方法对1993年4月至2002年3月收治的56例施行经腹根治性全胃切除术的贲门癌患者的临床资料进行回顾性分析。结果 56例贲门癌患者的淋巴结转移阳性率为71.4%(40/56),其中19例行腹主动脉旁淋巴结清扫,其16组淋巴结转移阳性率为31.6%(6/19);肿瘤浸润深度、Borrmann 分型、肿瘤大小以及食管侵犯是影响淋巴结转移的重要因素;术后合并症发生率为21.4%(12/56),围手术期死亡率为3.6%(2/56);1年、3年、5年生存率分别为77.6%、47.7%、37.1%,单因素分析显示淋巴结转移、组织类型、肿瘤大小、Borrmann 分型、浸润深度及侵犯食管对患者生存均有显著影响;淋巴结转移阴性组5年生存率为63.3%,阳性组5年生存率为25.4%,两组间差异具有统计学意义(P=0.011),Cox 多因素分析表明淋巴结转移可作为影响预后的独立因素(P=0.042)。结论经腹根治性全胃切除术是治疗贲门癌的安全有效术式;淋巴结转移是影响贲门癌预后的重要因素。
Objective To investigate the effect of radical gastrectomy in the treatment of patients with cardiac cancer and analyze the factors that influence its prognosis. Methods The clinical data of 56 patients with cardiac cancer undergoing total gastrectomy from April 1993 to March 2002 were retrospectively analyzed. Results The positive rate of lymph node metastasis in 56 patients with cardia cancer was 71.4% (40/56). Among them, 19 cases had para-aortic lymph node dissection, and the positive rate of lymph node metastasis in 16 cases was 31.6% (6/19). The depth of tumor infiltration , Borrmann classification, tumor size and esophageal invasion were the important factors affecting the lymph node metastasis. The incidence of postoperative complications was 21.4% (12/56) and perioperative mortality was 3.6% (2/56) The 3-year and 5-year survival rates were 77.6%, 47.7% and 37.1% respectively. Univariate analysis showed that lymph node metastasis, tissue type, tumor size, Borrmann’s classification, invasion depth and esophageal invasion had significant effects on the survival of patients. Lymph node metastasis The 5-year survival rate was 63.3% in the negative group and 25.4% in the positive group. The difference between the two groups was statistically significant (P = 0.011). Cox multivariate analysis showed that lymph node metastasis was an independent factor affecting prognosis = 0.042). Conclusions Radical gastrectomy is a safe and effective procedure for the treatment of cardia cancer. Lymph node metastasis is an important factor affecting the prognosis of cardia cancer.