胃癌腹膜扩散的临床病理特征及预后分析

目的 探讨胃癌腹膜扩散患者的临床病理因素以及姑息性切除术对其预后的影响。方法 回顾性分析1994年8月至2005年7月间胃癌数据库资料中患者的临床病理资料及随访结果。结果 792例原发性胃癌患者中发生腹膜扩散105例（13．3％）。肿瘤穿透浆膜、淋巴结转移、全胃癌、未分化癌、BorrmannⅣ型、女性患者与腹膜扩散相关（P〈0．05）。腹膜扩散患者1、3、5年生存率分别为57％、23％、22％。接受姑息性切除术患者术后1、3、5年生存率分别为66％、25％和20％，姑息性切除术后1年内各时点生存率均高于接受旁路手术或喂食性造口术患者和仅行剖腹探查患者（P〈0．05），而3组间术后3、5年生存率比较差异无统计学意义。结论 胃癌腹膜扩散患者具有较差的临床病理特征；姑息性切除术可改善胃癌腹膜扩散患者的近期预后。

Clinicopathologic characteristics and prognosis in patients with gastric cancer complicated by peritoneal dissemination

Objective To investigate the correlation between clinicopathologic factors and peritoneal dissemination from gastric cancer, and the impact of palliative resection on the prognosis of patients with gastric cancer complicated by peritoneal dissemination. Methods Based on our database built in 1994, the clinicopathologic data and the result of follow-up of all gastric cancer patients were analyzed retrospectively using the software of SPSS. Results One hundred and five out of 792 (13. 3% ) patients with primary gastric cancer were found complicated with peritoneal dissemination. The clinicopathologic factors in patients with peritoneal dissemination were significantly correlated with primary tumor penetrating through serosa, lymph node metastasis, primary tumor involving whole stomach, undifferentiated carcinoma, Borrmann IV and female gender (P <0. 05). The 1-, 3- and 5-year survival rate of the patients with peritoneal dissemination were 57% , 23% and 22% , respectively. The 1-, 3- and 5-year survival rate of the patients undergoing palliative resection were 66% , 25% and 20% , respectively. The overall survival rates of the patients undergoing palliative resection within 1 year after the operation were significantly higher than that of the patients undergoing by-pass operation/feeding neostomy and the patients undergoing exploratory laparotomy only ( P < 0. 05). Conclusion Patients of gastric cancer complicated with peritoneal dissemination are with untoward clinicopathologic characteristics. Palliative resection improves the short-term prognosis of these patients.