论文部分内容阅读
目的 探讨肿瘤侵及邻近结构 (tumorinvadesadjacentstructures ,T4 )的胃底贲门癌外科治疗的最佳方式。 方法 对 2 0 1例T4 胃底贲门癌进行外科治疗 ,其中探查手术 31例 ,联合脏器切除术 170例。对联合脏器切除术后 3、5年生存率及术后病死率和并发症发生率进行分析。 结果探查手术和联合脏器切除术患者的中位生存期分别为 4 9个月和 2 9 3个月 ,二者间差异有非常显著性意义 ( χ2 =37 0 80 ,P <0 0 1)。 170例施行联合脏器切除术患者的 3、5年生存率分别为 46 2 %、2 2 8% ;其中全胃切除术患者的 3、5年生存率分别为 5 4 9%、2 9 2 % ,明显高于近侧胃大部切除术患者的 32 2 %、12 5 % ( χ2 =7 5 89、P <0 0 1,χ2 =5 792、P <0 0 5 )。术后病死率和并发症发生率分别为4 1%和 2 4 1%。结论 对于T4 胃底贲门癌患者 ,只要术中没有发现肝脏血行转移、淋巴结广泛转移和腹膜种植转移等 ,局部病变允许行联合脏器整块切除 ,且患者的身体状况许可 ,就应尽可能施行联合脏器切除术 ,以达到根治的目的。全胃切除术能够提高疗效。
Objective To investigate the best way of surgically treating gastric cardia carcinoma of the stomach invaded by nearby tumor invadesadjacentstructures (T4). Methods Twenty - one cases of T4 gastric cardia carcinoma were treated surgically, of which 31 cases were exploration operation and 170 cases were treated with organ resection. After 3-5 years of combined organ resection, the 5-year survival rate and postoperative morbidity and mortality were analyzed. Results The median survival time of exploration and combined organ resection was 49 and 293 months, respectively, with significant difference (χ2 = 37 0 80, P 0 01) . The 3-year and 5-year survival rates of 170 patients who underwent combined organ resection were 46 2% and 22 8% respectively. The 3 and 5 year survival rates of total gastrectomy patients were 54.9% and 292% respectively %, Which was significantly higher than 32 2% and 125% in patients undergoing subtotal gastrectomy (χ2 = 7 5 89, P <0.01, χ2 = 5 792, P <0 05). Postoperative mortality and complication rates were 41% and 24%, respectively. Conclusion For patients with T4 gastric cardia and gastric cardia cancer, as long as no hematogenous hematogenous metastasis, extensive lymph node metastasis and peritoneal metastasis are found in the operation, the local lesion allows for the combined resection of the organ, and the patient’s physical condition should be implemented as far as possible Joint organ resection in order to achieve the purpose of radical. Total gastrectomy can improve the curative effect.