不同切除方案对胃中部癌患者远期预后的影响因素分析

目的：探讨影响不同切除方案对胃中部癌患者远期预后的因素。方法回顾性分析我院行手术治疗280例胃中部癌患者的临床资料，其中行全胃切除术患者194例（TG组），行远端胃大部切除术患者86例（DG组），比较两组胃中部癌患者的5年生存率及其影响因素。结果 TG组和DG组的5年生存率分别为47.6%和64.3%，差异具有统计学意义（P〈0.05）。但是，TG组患者相对肿瘤更大、分期更晚且肿瘤位于小弯侧者居多（均P〈0.05）。TNM分期预后分析显示，两组胃中部癌患者术后5年生存率比较差异无统计学意义（P〉0.05）；胃中部癌患者不同近切缘距离者的5年生存率差异也均无统计学意义（P〉0.05）。经多因素预后分析显示，胃切除方式不是胃中部癌患者独立的预后因素（P〉0.05）；而浸润深度和TNM分期是胃中部癌患者独立的预后影响因素（均P〈0.05）。结论在能够根治的手术前提下，不同的切除方案并不会影响胃中部癌患者的远期预后，但胃中部癌患者若能够满足彻底根除的条件，则实施远端胃大部切除术是可行的。

Analysis of influence factors of the long-term prognosis of different schemes on patients with gastric resection in cancer

Objective To explore the influence of the long-term prognosis of the different gastric resection on the patients with middle third gastric cancer. Methods The clinical data of 280 patients with middle third gastric carcinomas underwent radical resection were analyzed. And 194 patients underwent total gastrectomy （TG group） in them, while 86 patients underwent distal gastrectomy （DG group）. The five year survival rates were compared be-tween the two groups. By univariate and multivariate analyses, the prognostic factors were evaluated. Results The 5 year survival rate of TG group and DG group were 47.6%and 64.3%respectively, and the difference was statistically significant （P〈0.05）. However, patients in group TG had relatively greater tumor and later staging, and tumors located in the lessercurvature side mostly （P〈0.05）. TNM staging prognosis analysis showed that two groups of middle third gastric cancer patients after 5 year survival rate had no significant difference （P〉0.05）;5 year survival rate of patients with gastric cancer in different central incisal margin also had no statistical significance （P〉0.05）. Multivariate analy-sis showed that, stomach resection was not the independent prognostic factors of gastric cancer patients （P〉0.05）;and the depth of invasion and TNM stage were the factors affecting the prognosis of gastric cancer patients （P〈0.05）. Conclusion On the premise of radical operation, nearly cutting edge distance does not affect the long-term prognosis of patients with middle gastric cancer. If the middle third gastric carcinoma patients can achieve the requirements of complete eradication, the implementation of distal gastrectomy is feasible.