脏器联合切除治疗T4期胃癌69例分析

目的　评价脏器联合切除术治疗T4期胃癌的疗效 ,探讨其手术指征。　方法　回顾性分析 1992年～ 2 0 0 1年行脏器联合切除 (CR组 )的 6 9例T4期胃癌患者的临床资料及随访结果 ,并与同期 4 5例姑息性胃切除患者 (NCR组 )相比较。　结果　CR组 6 9例中 ,根治性切除 5 4例 ,姑息性切除15例 ;其中联合横结肠切除 2 4例 ,胰体尾脾切除 2 2例 ,肝左外叶切除 8例 ,胰体尾脾横结肠切除 6例 ,胰十二指肠切除 5例 ,胆囊切除 2例 ,膈肌、脾脏切除各 1例 ;总淋巴结转移率 88 4 % ,围手术期死亡 3例 (4 3% ) ,合并症发生率 14 5 % ,CR组和NCR组术后 1、3、5年生存率分别为 6 6 9%、39 1%、2 6 8%和 33 4 %、7 4 %、0 (P <0 0 1) ,根治性脏器联合切除组 5年生存率为 34 1%。结论　脏器联合切除术可提高T4期胃癌的 5年生存率

Clinical analysis of combined resection for T4 gastric cancer: report of 69 cases

Objective To evaluate the effect of combined resection for the treatment of T 4 gastric cancer and to refine the indication for enbloc dissection. Methods Clinical data of 69 cases receiving combined resection were analyzed retrospectively, and compared with those of 45 cases undergoing palliative gastrectomy. Results Of 69 cases,54 patients underwent curative combined resection,15 patients underwent palliative combined resection, including 24 with transverse colectomy,22 with pancreaticosplenectomy,8 with left lateral lobectomy of liver,6 with pancreaticosplenectomy and transverse colectomy,5 with pancreaticoduodenectomy, 2 with cholecystectomy,1 with splenectomy,1 with phrenectomy.The total rate of lymph node metastasis was 88 4%; the operative mortality rate was 4 3%; the morbidity rate was 14 5%. The postoperatively 1 ,3 ,5 year survival rates of CR group and NCR group were 66 9%,39 1%,26 8% and 33 4%,7 4%,0% respectively ( P <0 01).The five year survival rate of curative resection group was 34 1%. Conclusions An enbloc combined resection can cure some T 4 patients,and improve the five year survival rate.