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目的:探讨胃癌术后复发再手术对提高胃癌术后生存率的意义。方法:回顾性分析7年间在胃癌术后复发手术病例57例,临床资料包括首次及本次复发诊断及手术情况,术后随访信息。结果:胃癌术后复发最主要症状是上腹部隐痛不适27例(47.4%)。复发癌肿切除32例(56.1%),手术方法包括残胃切除21例,加脾切除术6例,脾切除术加肾上腺切除术1例,胰十二指肠切除术1例,胰体尾切除术1例,胰十二指肠切除术加横结肠切除术1例,肝部分切除术2例。肿瘤切除组术后生存期27.8月,显著大于姑息性手术组(4.7个月)及剖腹探查组(3.1个月)(P<0.001)。结论:胃癌术后复发再手术可适用于局部复发的少数病例,如能获得根治性切除,则能提高生存率,姑息性手术对延长生存期无明显效果。
Objective: To explore the significance of postoperative recurrence of gastric cancer and its effect on postoperative survival of gastric cancer. Methods: A retrospective analysis of 57 cases of postoperative recurrence of gastric cancer in 7 years was performed. The clinical data included the diagnosis of the first and the recurrence and the operation and postoperative follow-up information. Results: The main symptom of gastric cancer recurrence was upper abdomen pain and discomfort in 27 cases (47.4%). Thirty-two cases (56.1%) underwent resection of the cancer, including 21 cases of residual gastrectomy, 6 cases of splenectomy, 1 case of splenectomy plus adrenalectomy, 1 case of pancreatoduodenectomy, 1 case of resection, pancreatoduodenectomy plus transverse colon resection in 1 case, partial hepatectomy in 2 cases. The survival time of tumor resection group was significantly larger than that of palliative surgery group (4.7 months) and laparotomy group (3.1 months) at 27.8 months (P <0.001). Conclusion: Recurrence and reoperation of gastric cancer can be applied to a few cases of local recurrence. If radical resection can be achieved, the survival rate can be improved. Palliative surgery has no obvious effect on prolonging survival.