CAJ | 학술논문

目的比较胃癌D_2根治术中联合脾切除与否对胃上部、上中部及全胃癌手术疗效的差异.方法 1989年1月至1994年12月间,对112例肿瘤位于胃上部、上中部或全胃的患者施行了D_2根治术,其中61例接受保脾改良淋巴结清除术(保脾组),51例接受D_2根治术联合脾切除(切脾组).回顾性分析两组患者在临床病理特征、5年生存率、术后并发症发生率和术后住院天数等方面的差异.结果两组胃癌患者在性别、年龄、肿瘤大小、肿瘤T分期和N分期及TNM分期间差异均无统计学意义(均P>0.05).保脾组和切脾组胃癌患者的术后5年总体生存率分别为41.0%和39.2%(P>0.05).保脾组Ⅰ、Ⅱ、Ⅲ、Ⅳ期胃癌患者的5年生存率分别为100.0%、66.7%、27.8%和17.4%,切脾组分别为100.0%、70.0%、26.7%和5.6%.两组各分期患者术后5年生存率差异均无统计学意义(P>0.05);保脾组和切脾组胃癌患者的术后并发症发生率分别为11.5%和27.5%.两组间差异有统计学意义(P<0.05);切脾组胃癌患者的术后平均住院天数(27.3 d)长于保脾组(20.3 d)(P=0.057).结论对于胃上部、上中部或全胃癌,保脾改良淋巴结清除的D_2全胃根治术不仅能取得与联合脾切除的D_2全胃根治术相当的疗效,而且可以减少术后并发症的发生率.
목적 비교위암D_2근치술중연합비절제여부대위상부、상중부급전위암수술료효적차이.방법 1989년1월지1994년12월간,대112례종류위우위상부、상중부혹전위적환자시행료D_2근치술,기중61례접수보비개량림파결청제술(보비조),51례접수D_2근치술연합비절제(절비조).회고성분석량조환자재림상병리특정、5년생존솔、술후병발증발생솔화술후주원천수등방면적차이.결과 량조위암환자재성별、년령、종류대소、종류T분기화N분기급TNM분기간차이균무통계학의의(균P>0.05).보비조화절비조위암환자적술후5년총체생존솔분별위41.0%화39.2%(P>0.05).보비조Ⅰ、Ⅱ、Ⅲ、Ⅳ기위암환자적5년생존솔분별위100.0%、66.7%、27.8%화17.4%,절비조분별위100.0%、70.0%、26.7%화5.6%.량조각분기환자술후5년생존솔차이균무통계학의의(P>0.05);보비조화절비조위암환자적술후병발증발생솔분별위11.5%화27.5%.량조간차이유통계학의의(P<0.05);절비조위암환자적술후평균주원천수(27.3 d)장우보비조(20.3 d)(P=0.057).결론 대우위상부、상중부혹전위암,보비개량림파결청제적D_2전위근치술불부능취득여연합비절제적D_2전위근치술상당적료효,이차가이감소술후병발증적발생솔.
Objective To compare the efficacy of modified D_2 radical total gastrectomy with spleen-preserving and D_2 radical total gastrectomy with splenectomy in patients with gastric cancer located in the upper third, upper and middle third and entire stomach. Methods One hundred and twelve patients with gastric cancer in the upper third, upper and middle third, or entire stomach underwent radical total gastrectomy between January 1989 and December 1994. Modified D_2 total radical gastrectomy with spleen-preserving(spleen-preservation group)was performed in 61 patients,and 51 underwent D_2 total radical gastrectomy with splenectomy(splenectomy group). The differences in clinicopathological characteristics, 5-year survival rate, incidence of postoperative complication and hospital stay between the two groups were analyzed retrospectively. Results There were no significant differences between the spleen-preservation group and the splenectomy group in gender, age, tumor size, T stage, N stage and TNM stage. The overall 5-year survival rate was 41.0% in the spleen-preservation group and 39.2% in the splenectomy group (P>0.05). The 5-year survival rates of patients with stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 100%, 66.7%, 27.8% and 17.4% in the spleen-preservation group, respectively, and were 100%, 70.0%, 26.7% and 5.6% in the splenectomy group, respectively (all P>0.05). The incidence of postoperative complication was lower in the spleen-preservation group (11.5% vs 27.5%, P<0.05). The mean hospital stay was longer in the splenectomy group (27.3 d vs 20.3 d,P=0.057). Conclusion The efficacy of modified D_2 radical total gastrectomy with spleen-preserving for patients with gastric cancer in the upper third, upper and middle third or entire stomach is similar to that of D_2 radical total gastrectomy with splenectomy, and the spleen-preserving procedure is associated with decreased postoperative complication and improved survival.