CAJ | 학술논문

目的探讨胃切除方式对胃中部癌患者预后的影响.方法回顾性分析1998年1月至2005年12月间福建医科大学附属协和医院收治的222例胃中部癌患者的临床资料,其中行开腹远端胃大部切除术66例(DG组),行开腹全胃切除术患者156例(TG组),比较两组患者术后5年的生存率.结果 DG组和TG组术后5年生存率分别为63.9％和49.8％,差异具有统计学意义(P＜0.05).但相比之下,TG组患者肿瘤更大、分期更晚、肿瘤位于小弯侧者居多(均P＜0.01).按TNM分期进行分层预后分析显示,相同病期的两组患者术后5年生存率的差异均无统计学意义(均P＞0.05).无论是以4 cm、5 cm还是6 cm作为近切缘截点,不同近切缘距离患者5年生存率的差异均无统计学意义(均P＞0.05).多因素预后分析显示,浸润深度、淋巴结转移和TNM分期是独立预后影响因素(均P＜0.05);而胃切除方式并不是独立预后因素(P＞0.05).结论胃中部癌患者如果能够达到根治手术的要求,其预后不受胃切除方式的影响,行远端胃大部切除术是可行的.
목적 탐토위절제방식대위중부암환자예후적영향.방법 회고성분석1998년1월지2005년12월간복건의과대학부속협화의원수치적222례위중부암환자적림상자료,기중행개복원단위대부절제술66례(DG조),행개복전위절제술환자156례(TG조),비교량조환자술후5년적생존솔.결과 DG조화TG조술후5년생존솔분별위63.9％화49.8％,차이구유통계학의의(P＜0.05).단상비지하,TG조환자종류경대、분기경만、종류위우소만측자거다(균P＜0.01).안TNM분기진행분층예후분석현시,상동병기적량조환자술후5년생존솔적차이균무통계학의의(균P＞0.05).무론시이4 cm、5 cm환시6 cm작위근절연절점,불동근절연거리환자5년생존솔적차이균무통계학의의(균P＞0.05).다인소예후분석현시,침윤심도、림파결전이화TNM분기시독립예후영향인소(균P＜0.05);이위절제방식병불시독립예후인소(P＞0.05).결론 위중부암환자여과능구체도근치수술적요구,기예후불수위절제방식적영향,행원단위대부절제술시가행적.
Objective To investigate the impact of the extent of gastric resection on the prognosis of patients with middle one-third gastric cancer.Methods From January 1998 to December 2005,222 patients with middle one-third gastric cancer underwent D2 radical resection in the AffiliatedUnion Hospital,Fujian Medical University.Among them,66 underwent distal gastrectomy(DG group),while 156 underwent total gastrectomy(TG group).The 5-year survival rates were compared between two groups.The prognostic factors were evaluated by univariate and multivariate analyses.Results The 5-year survival rates of DG group and TG group were 63.9％ and 49.8％ respectively,with significant difference (P＜0.05).Nevertheless,compared to DG group,the tumors in TG group had bigger size,later TNM stage,and higher proportion of locating lesser curvature of stomach (all P＜0.01).Multivariate analysis revealed that invasion depth,lymph node metastasis and TNM classification were independent prognostic factors (all P＜0.05),but the extent of gastric resection was not(P＞0.05).Conclusion If curative resection can be performed,the long-term prognosis of patients with middle one-third gastric cancer is not affected by the extent of gastric resection,and distal gastrectomy is feasible.