胃癌1072例外科治疗

目的探讨胃癌手术治疗的方法。方法回顾性分析1992年1月至2004年12月间1072例患者行外科手术治疗的临床资料。结果手术切除922例（86％），其中根治性手术783例（73％），姑息性切除139例（12．9％），在所有切除的手术中，近端胃大部切除239例，远端胃大部切除361例，全胃切除322例，其中空肠间置代胃132例，空肠P襻Roux—Y代胃术200例，联合脏器切除92例，手术探查150例。D1手术86例，D2手术592例，D3手术99例，D4手术6例。TNM分期：Ⅱ期102例，Ⅱ期269例，ⅢA期378例，ⅢB期172例，Ⅳ期151例，Ⅲ、Ⅳ期患者占65．4％。总的1、3、5年生存率分别为74．6％、61．7％、41．1％。其中根治陛手术的1、3、5年生存率为83．1％、65．2％、45．8％。手术死亡率0．5％，手术并发症发生率4．9％。结论根治性手术切除是治疗胃癌的关键，术式的选择和代胃方式、联合脏器切除、预防切端癌残留和手术并发症、术后辅助性化疗可提高生存率和生存质量。

Surgical treatment for gastric cancer in 1072 cases

Objective To analyze, the surgical treatment for gastric cancer. Methods Clinical data of 1072 patients with gastric cancer were analyzed retrospectively. Results The main clinical manifestations included upper abdominal pain(671 cases), difficulty in swallow(311 cases), appetite loss(187 cases),wasting or weight loss(158 cases), nausea and vomiting(97 cases), distention or upset(178 cases) and hematochezia (116 cases). 922 of 1072 patients (86 %) underwent resection, including 783 radical operation and 139 pauiative operation, including 239 proximal gastrectomy,361 distal gastrectomy and 322 total gastrectomy (jejunal interposition in 132 cases and "P"-Roux-en-y reconstruction in 200 cases). 92 cases received combined organs resection while 150 cases received exploratory laparotomy among them. D1 lymphadenectomy was performed for 86 cases and D2 lymphadenectomy 592 cases, D3 99 cases, and D4 6 cases. Stage Ⅰ accounted for 102 cases and stage Ⅱ269 cases, ⅢA 378 cases, ⅢB 172 cases, and stage Ⅳ 151 cases. The 1, 3,5 year overall survival rate were 74.6 %, 61.7 % and 41.1% in all cases but 83.1%, 65.2 % and 45.8 % in the group under radical treatment of gastric carcinoma. Conclusion To increase the survival rate and improve the quality of life,we shall pay attention to surgical procedure,digestive tract reconstruction,prevention of positive stump and postoperative complications in gastric cancer.