2335例胃癌外科治疗的临床分析

目的探讨胃癌外科治疗的临床疗效和影响预后的因素。方法应用我院建立的胃癌数据库资料，回顾性分析解放军总医院1996年1月至2005年12月2335例胃癌外科手术患者的临床病理因素及治疗措施对预后的影响。结果全组男性患者占81．0％，女性19．0％；男女之比4．3：1．0。50岁以下患者占22．8％，50岁以上者占77.2％。早期胃癌275例，占11．8％；其余88．2％均为进展期胃癌。72．8％的患者肿瘤直径超过4cm，69．6％的患者其肿瘤呈低分化。1690例（72．4％）患者进行了根治性切除手术，其余为姑息性切除或探查；术后予以综合治疗者1538例（65．9％）。全组总的1、3、5年生存率分别为71．9％、45．3％和40．1％。经单因素和多因素分析显示，影响胃癌生存的独立预后因素分别是手术方式（P〈0．01）、TNM分期（P〈0．01）和综合治疗（P〈0．01）。结论手术根治程度、肿瘤TNM分期和综合治疗是影响胃癌患者预后重要因素，早期手术和根治性手术是治愈胃癌最有效的手段。

Surgical treatment for patients with gastric cancer:report of 2335 cases

OBJECTIVE: To clarify the important factors affecting the prognosis of patient with gastric carcinoma. METHODS: The data of 2335 cases of resected gastric carcinoma from Jan. 1996 to Dec. 2005 were studied by using univariate analysis and multivariate regression analysis. RESULTS: Male patients accounted for 81.0% and female patients 19.0%. The ratio of male to female was 4.2: 1.0. Patients under 50 years old accounted for 77.2%. Two hundred and seventy-five cases were early gastric cancer, accounting for 11.8%, and another 2060 cases were advanced gastric cancer, accounting for 88.2%. Tumor diameter of 72.8% patients was more than 4 cm and 69.6% cases suffered with low differentiated cancer. Curative resections were performed in 1690 patients (72.4%) and palliative operation in other patients. After operation, 1538 cases (65.9%) received comprehensive treatment. For all cases, the 1-, 3- and 5-year survival rates were 71.9%, 45.3% and 40.1% respectively. The independent risk factors influencing prognosis of these patients were Borrmann classification,TNM staging, curative resection and multidisciplinary treatment through univariate and multivariate analyses. CONCLUSION: The factors influencing prognosis of patient with gastric carcinoma after resection are Borrmann classification,TNM staging, curative resection and multidisciplinary treatment. Early and curative resection is the most important management to improve therapeutic efficacy of stomach cancer.