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目的:探讨贲门癌根治术中保留脾脏的脾门淋巴结清扫与切除脾脏对患者术后生存的影响。方法:回顾性分析我院2004至2007年因贲门癌行根治性全胃切除术的135例患者的资料,其中保留脾脏并行脾门淋巴结清扫的患者61例,切除脾脏的患者74例。详细记录患者临床病理资料,术后定期随访,详细记录患者术后生存时间。结果:两组患者的年龄、性别、肿瘤大小、Borrmann分型、分化程度、浸润深度及TNM分期之间差异无统计学意义(P>0.05)。两组患者手术时间、术中出血量、首次排气排便时间、术后住院时间差异无统计学意义(P>0.05),但切除脾脏组患者术后总体并发症发生率显著高于保留脾脏组(P<0.05)。切除脾脏组患者平均清扫的脾门淋巴结数目和检测出的平均阳性淋巴结数均显著高于保留脾脏组(P<0.05)。脾门淋巴结转移与肿瘤大小、分化程度及浸润深度密切相关(P<0.05)。两组患者术后5年生存率差异无统计学意义(P>0.05),但脾门淋巴结阴性患者术后5年生存率要显著高于脾门淋巴结阳性患者(P<0.05)。结论:对于因贲门癌行根治性全胃切除术的患者,切除脾脏并不能显著延长患者术后生存时间。
Objective: To investigate the effect of splenic lymph node dissection and splenectomy after spleen preservation on the survival of patients undergoing cardiac surgery. Methods: The data of 135 patients who underwent radical total gastrectomy for cardia cancer from 2004 to 2007 in our hospital were retrospectively analyzed. There were 61 patients with splenic lymph node dissection in spleen and 74 patients with splenectomy. Detailed records of patients with clinical and pathological data, regular follow-up after surgery, detailed records of patients with postoperative survival time. Results: There were no significant differences in age, sex, tumor size, Borrmann classification, differentiation degree, depth of invasion and TNM staging between the two groups (P> 0.05). There was no significant difference in the operation time, blood loss, time to first defecation and postoperative hospital stay between the two groups (P> 0.05). However, the overall incidence of postoperative complications in patients with splenectomy was significantly higher than that in spleen (P <0.05). The average number of splenic lymph nodes dissected and the mean number of positive lymph nodes detected in patients with splenectomy were significantly higher than that of spleen preserved spleen (P <0.05). The splenic lymph node metastasis was closely related to tumor size, differentiation and infiltration depth (P <0.05). The 5-year survival rate of the two groups had no significant difference (P> 0.05). However, the 5-year survival rate of patients with negative splenic lymph nodes was significantly higher than that of patients with splenomegaly (P <0.05). Conclusions: Excision of the spleen does not significantly prolong postoperative survival in patients undergoing cardiac total gastrectomy for cardia cancer.