中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2009年
2期
113-116
,共4页
胃肿瘤,早期%胃肿瘤,浅表广泛型%临床病理特点%手术方式
胃腫瘤,早期%胃腫瘤,淺錶廣汎型%臨床病理特點%手術方式
위종류,조기%위종류,천표엄범형%림상병리특점%수술방식
Stomach neoplasms,early%Stomach neoplasms,superficial spreading type%Clinicopathological characteristics%Type of operation
目的 了解浅表广泛型早期胃癌(EGC)患者的临床病理特点和预后,探讨其合理的手术方式.方法 收集62例临床病理资料完整的浅表广泛型EGC和224例一般型EGC患者的临床资料,分析比较两组病例的临床病理特点、治疗方法及预后.结果 本组浅表广泛型EGC位于胃体中部及全胃者占45.2%.混合型占48.4%(ⅡC加ⅡA 5例、ⅡC加ⅡB 16例、ⅡC加Ⅲ9例);全胃切除术者占16.1%,扩大手术者40.3%.单因素分析发现,浅表广泛型与一般型EGC患者在年龄、性别、肿瘤浸润深度、分化程度、生长方式、脉管癌栓和淋巴结转移方面差异无统计学意义(P>0.05):而在肿瘤部位、大体类型和胃切除范围及手术方式方面差异有统计学意义(P<0.01).浅表广泛型EGC术后10年无瘤生存率为91.4%,与一般型EGC比较差异无统计学意义(χ2=1.16,P=0.282).结论 浅表广泛型EGC具有与一般型EGC不同的临床病理特征,但预后与一般型EGC没有明显差异.防止胃切断端癌残留和胃内多发癌在残胃内遗留是手术成功的关键,以施行标准根治术(D2)为宜.
目的 瞭解淺錶廣汎型早期胃癌(EGC)患者的臨床病理特點和預後,探討其閤理的手術方式.方法 收集62例臨床病理資料完整的淺錶廣汎型EGC和224例一般型EGC患者的臨床資料,分析比較兩組病例的臨床病理特點、治療方法及預後.結果 本組淺錶廣汎型EGC位于胃體中部及全胃者佔45.2%.混閤型佔48.4%(ⅡC加ⅡA 5例、ⅡC加ⅡB 16例、ⅡC加Ⅲ9例);全胃切除術者佔16.1%,擴大手術者40.3%.單因素分析髮現,淺錶廣汎型與一般型EGC患者在年齡、性彆、腫瘤浸潤深度、分化程度、生長方式、脈管癌栓和淋巴結轉移方麵差異無統計學意義(P>0.05):而在腫瘤部位、大體類型和胃切除範圍及手術方式方麵差異有統計學意義(P<0.01).淺錶廣汎型EGC術後10年無瘤生存率為91.4%,與一般型EGC比較差異無統計學意義(χ2=1.16,P=0.282).結論 淺錶廣汎型EGC具有與一般型EGC不同的臨床病理特徵,但預後與一般型EGC沒有明顯差異.防止胃切斷耑癌殘留和胃內多髮癌在殘胃內遺留是手術成功的關鍵,以施行標準根治術(D2)為宜.
목적 료해천표엄범형조기위암(EGC)환자적림상병리특점화예후,탐토기합리적수술방식.방법 수집62례림상병리자료완정적천표엄범형EGC화224례일반형EGC환자적림상자료,분석비교량조병례적림상병리특점、치료방법급예후.결과 본조천표엄범형EGC위우위체중부급전위자점45.2%.혼합형점48.4%(ⅡC가ⅡA 5례、ⅡC가ⅡB 16례、ⅡC가Ⅲ9례);전위절제술자점16.1%,확대수술자40.3%.단인소분석발현,천표엄범형여일반형EGC환자재년령、성별、종류침윤심도、분화정도、생장방식、맥관암전화림파결전이방면차이무통계학의의(P>0.05):이재종류부위、대체류형화위절제범위급수술방식방면차이유통계학의의(P<0.01).천표엄범형EGC술후10년무류생존솔위91.4%,여일반형EGC비교차이무통계학의의(χ2=1.16,P=0.282).결론 천표엄범형EGC구유여일반형EGC불동적림상병리특정,단예후여일반형EGC몰유명현차이.방지위절단단암잔류화위내다발암재잔위내유류시수술성공적관건,이시행표준근치술(D2)위의.
Objective To clarify the clinicopathological features and prognosis, and to evaluate the rational surgical therapy for superficial spreading early gastric cancer (EGC). Methods Superficial spreading EGC was defined as tumor invading the mucosa or submucosa layer with the diameter ≥50 ram, and common EGC as tumor with diameter < 50 mm. The clinicopathological data of 62 patients with superficial spreading EGC and 224 patients with common EGC were collected and analyzed retrospectively. Results No significant differences in age, sex, differentiation, depth of invasion, growth manner, vessel involvement and lymph node metastasis were found between superficial spreading and common EGC (P>0.05), but significant differences were seen in tumor site, macroscopic type, scope of gastrectomy and lymphadenectomy between the two groups (P<0.05). Superficial spreading EGC located in the middle or the whole of stomach accounted for 45.2%, and presented mixed macroscopic type more frequently(48.4%), such as ⅡC + ⅡA 5 cases, ⅡC + ⅡB 9 cases and ⅡC+ Ⅲ 16 cases, and more total gastrectomy and more D2 lymphadenectomy (16.1% and 40.3% respectively) were executed, compared with common EGC. Due to cancer residual,two patients underwent enlargement of the scope of gastrectomy,two underwent total gastreetomy and one underwent operation again after surgery. The 5-, 10-year tumor-free survival rates for superficial spreading EGC were 98.4% and 91.4%, while 97.0% and 91.2% for the common EGC (χ2=1.16,P=0.282). Conclusions Special clinicopathological features can be seen in superficial spreading EGC, and the lesion is superficial and extensive. Prevention of cancer residual in remnant stomach is the key point and D2 lymphadenectomy is suitable enough for operation.
