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目的比较分析残胃癌与同期近端胃癌的临床病理特征及预后。方法 1998年1月至2010年12月接受手术治疗并资料齐全的残胃癌62例(溃疡术后38例,胃癌术后24例)、近端癌组417例。比较两组患者的临床病理特征及预后,同时比较根治术对两组患者的手术创伤程度(手术时间、术中输血量、术后住院天数、术后并发症),分析根治术对残胃癌的预后影响。结果两组患者的性别、肿瘤直径、浸润深度、淋巴结转移、TNM分期、Borrmann分型、血清CEA等比较,差异均无统计学意义(均P>0.05)。残胃癌与近端癌患者中位年龄分别为64和60岁,远处转移率分别为30.6%和17.7%,黏液腺癌与印戒细胞癌比例分别29%和12%,低分化癌比例67.7%和56.4%,根治切除率79.0%、89.4%,两组比较差异均有统计学意义(均P<0.05)。回归分析表明,浸润深度、淋巴结转移、远处转移为根治术的独立影响因素,而残胃癌不是根治术的独立影响因素(P=0.227)。在根治前提下,残胃癌组与近端癌组手术时间、术中输血量、术后住院天数、术后并发症等比较,差异均无统计学意义(均P>0.05)。残胃癌组与近端癌组的中位生存期分别为19、31个月(P<0.05),根治切除后两组中位生存期分别为28、40个月(P>0.05)。对残胃癌患者,接受根治术和非根治术者的中位生存期分别为28、7个月(P<0.05)。结论残胃癌较近端胃癌容易发生远处转移,导致根治率降低,预后不良。根治性切除能显著改善残胃癌预后,较近端癌根治术相比,残胃癌根治术并不增加患者的手术创伤。
Objective To comparatively analyze the clinicopathological features and prognosis of gastric stump carcinoma and proximal gastric cancer. Methods From January 1998 to December 2010, 62 cases of gastric residual cancer (38 cases after ulcer surgery, 24 cases after gastric cancer surgery) and 417 cases of proximal cancer were undergone surgical treatment. The clinical and pathological features and prognosis of the two groups were compared. At the same time, the degree of surgical trauma (operation time, intraoperative blood transfusion, postoperative hospital stay, postoperative complications) of two groups were compared. Prognosis. Results There was no significant difference in gender, tumor diameter, depth of invasion, lymph node metastasis, TNM staging, Borrmann classification and serum CEA among the two groups (all P> 0.05). The median age of patients with residual gastric cancer and proximal cancer were 64 and 60 years respectively. The distant metastasis rates were 30.6% and 17.7%, respectively. The rates of mucinous adenocarcinoma and signet ring cell carcinoma were 29% and 12%, respectively. The proportion of poorly differentiated carcinoma was 67.7% % And 56.4% respectively. The radical resection rates were 79.0% and 89.4%, respectively. There was significant difference between the two groups (all P <0.05). Regression analysis showed that depth of invasion, lymph node metastasis and distant metastasis were the independent influential factors of radical operation, while residual gastric cancer was not an independent factor of radical operation (P = 0.227). Under the premise of radical treatment, there was no significant difference in operative time, intraoperative blood transfusion, postoperative hospital stay, postoperative complications between gastric cancer group and proximal cancer group (all P> 0.05). The median survival time of gastric cancer group and proximal cancer group was 19 and 31 months (P <0.05). The median survival time was 28 and 40 months after radical resection (P> 0.05). The median survival of patients with gastric cancer was 28 and 7 months, respectively (P <0.05). Conclusion Gastric stump cancer is more likely to metastasize than proximal gastric cancer, resulting in lower radical cure rate and poor prognosis. Radical resection can significantly improve the prognosis of residual gastric cancer, compared with radical resection, radical resection of gastric cancer does not increase the patient’s surgical trauma.