根Ⅰ式和根Ⅱ式胃切除术治疗进展期胃癌的比较

为评价根Ⅱ（Ｒ２）胃切除对胃癌病人的利弊，本文分析比较作根治性切除的进展期胃癌共１３１例，病人按淋巴结清扫的范围分成两组。６４例行Ｒ２胃切除，６７例行根Ⅰ（ＲＩ）胃切除。除Ｒ２组（３３／６４）全胃切除率比Ｒ１组（２２／６７）高（Ｐ＜０．０５）外，两组病人的临床和病理情况基本相似。手术时间Ｒ２组明显比Ｒ１组长（Ｐ＜０．０１），输血量Ｒ２比Ｒ１组大（Ｐ＜０．０１）。手术后住院天数两组无显著差别。Ｒ２组６４例中，５例（７．８％）发生外科并发症，Ｒ１组６７例中，发生这类并发症者仅１例（１．５％），两者差别有显著意义（Ｐ＜０．０５）。Ｒ２和Ｒ１组的死亡率为０％和１．５％，无显著差别。３年生存率Ｒ２组为５４．８％Ｒ１组为３７．８％，其差别有显著意义（Ｐ＜０．０５）。以上结果提示，Ｒ２胃切除是可行的，对能根治病例有提高生存率的作用。

COMPARISON OF R2 AND R1 GASTRECTOMY FOR ADVANCED GASTRIC CANCER

For the purpose of evaluating the benefit of R2 gastrectomy for gastric cancer in Chinese patients , a com- parative analysis was made on 131 patients with advanced gastric cancer undergoing resection with curative in- tent . The patients were catogorized according to the extent of lymphadenectomy : 6 7 underwent R 1 gastrecto- nay and 64 , R2 gastrectomy. The clinical and pathological characteristics of the patients between the two groups were comparable at the time of surgery. R2 gastrectomy involved a significantly longer operation time (P<0. 01) and larger volume of blood transfusion(P<0. 01). The two patient groups did not differ with re- gard to postoperative stay. Surgical complications occurred in 1 of the 67 patients with R1 gastrectomy , com- pared with 5 of the 64 patients with R2 gastrectomy , respectively (P<0.05) . When the survival rate was compared, the 3-year survival rates were higher for R2 group ( 54.8%) than for R1 group ( 37.8%), P< 0. 01. These findings suggest that R2 gastrectomy is acceptable and offers a significant survival benefit to cur- able chinese patients.