手术方式对不同腹腔转移类型胃癌预后的影响

目的 比较手术方式对不同腹腔转移类型胃癌预后的影响.方法 本组胃癌伴腹腔转移150例,按转移部位不同分为腹膜种植组(106例)、肝转移组(19例)、腹膜种植并肝转移组(25例).手术方法包括病灶全切除、病灶姑息切除、非病灶切除术,部分病例行淋巴结清扫.结果 腹膜种植组、肝转移组、腹膜种植并肝转移组的病灶全切除率分别为48.1%、63.2%和20.0%,淋巴结清扫率分别为48.1%、68.4%和20.0%,腹膜种植组和肝转移组显著高于腹膜种植并肝转移组(P<0.05),腹膜种植并肝转移组以病灶姑息切除(48.0%)和非淋巴结清扫术(80.0%)为主.腹膜种植组、肝转移组、腹膜种植并肝转移组的平均生存期分别为31.1、12.8、9.7个月,腹膜种植组预后最好,腹膜种植并肝转移组最差(P<0.05).腹膜种植组接受病灶全切除、病灶姑息切除、非病灶切除的平均生存期分别为46.3、17.7、4.8个月,各组之间差异均有统计学意义(P<0.05);肝转移组病灶全切除、病灶姑息切除、非病灶切除的平均生存期分别为17.2、4.0、5.4个月,病灶全切除能显著延长患者生存期(P<0.05);腹膜种植并肝转移组行病灶全切除、病灶姑息切除、非病灶切除的平均生存期分别为11.2、8.9、5.0个月,差异均无统计学意义(P>0.05).淋巴结清扫可显著延长腹膜种植组的生存期(P<0.05).结论 胃癌发生腹膜种植患者的预后比发生肝转移患者的好,病灶切除和规范的淋巴结清扫可改善腹膜种植或肝转移胃癌患者的预后.

The effect of operative modality on the prognosis of gastric carcinoma patients suffering from different types of intra-abdominal metastasis

Objective To study the effect of operative modalities on the prognosis of gastric carcinoma patients suffering from various types of intra-abdominal metastasis. Methods In this study, 150 cases of gastric cancer with abdominal metastasis screened from data base, were divided by the location into peritoneal dissemination group (n=106), hepatic metastasis group (n=19) and both peritoneal dissemination and hepatic metastasis group (n=25). The surgical interventions include total resection, palliative resection and no resection. The clinicopathological parameters and prognosis were analyzed. Results The total tumor resection rate in peritoneal dissemination group (48.1%) and hepatic metastasis group (63.2%) was significantly higher than that in both peritoneal and hepatic metastasis group (20.0%), with the mean survival time (months) being 31.1, 12.8, 9.7 respectively (P<0.05). In peritoneal group, the mean survival (months) for tumor total resection, palliative and no resection subgroup was 46.3,1.7,4.8 respectively (P<0.05), whereas in hepatic metastasis group, the mean survival (months) was 17.2,4.0,5.4 respectively (P<0.05), in both peritoneal and hepatic metastasis group, the mean survival (months) was 11.2,8.9,5.0 respectively (P>0.05). Lymph nodes resection significantly prolonged survival in peritoneal dissemination group. Conclusions The prognosis of gastric cancer with peritoneal dissemination is better than with hepatic metastasis. Tumor total resection and lymph node dissection significantly improve the survival of patients suffering from peritoneal or hepatic dissemination.