摘要目的探讨胃癌侵犯胰腺的术前诊断方法及其手术治疗价值。方法对420例胃癌患者术前行电子胃镜和(或)内镜超声检查、上腹部B超和(或)螺旋CT扫描。术前检测血清肿瘤相关抗原CEA、CA19-9、CA72-4水平。所有病例均接受外科手术，术中及术后病理证实胃癌侵犯胰腺者共62例，其中行联合胰腺切除的胃癌根治术37例，非根治术25例。结果内镜超声、CT扫描和B超检查对胃癌侵犯胰腺的术前诊断率分别为84.2%、 57.1%和25.8%。联合胰腺切除的根治手术组与非根治手术组比较，两组的生存期差异有显著性意义（P＜0.05）。结论内镜超声和CT扫描对胃癌侵犯胰腺的术前诊断有较大的帮助。联合胰腺切除的胃癌根治术可延长部分病例的生存期。

abstractsObjective　To study preoperative diagnosis of advanced gastric cancer (AGC) with pancreatic invasion and their value of surgical management.　Methods　420 patients with AGC were estimated preoperatively by electronic gastroscope and/or endoscopic ultrasound(EUS), epigastric B-ultrasound (BUS) and/or spiral CT scan. Serum tumor-related antigens including CEA, CA19-9 and CA72-4 were detected preoperatively. Sixty-two (14.8%) out of 420 AGC patients with pancreatic invasion were confirmed by intraoperative and postoperative pathological diagnosis. Of these, 37 patients underwent simultaneous pancreatectomy combined with gastric cancer radical operation, 25 underwent non-radical intervention.　Results　The diagnosis rate of EUS, spiral CT scan and BUS in patients with AGC with pancreatic invasion preoperatively was 84.2%, 57.1% and 25.8%, respectively. The 1-, 3- , and 5-year survival rate of patients with pancreatic invasion was 55.8%, 23.0% and 6.4%, respectively. There was a significant difference between the survival rate of patients who underwent radical operation ombined with simultaneous pancreatectomy and non-radical intervention (P＜0.05).　Conclusions　EUS and spiral CT scan are helpful in the preoperative diagnosis of AGC with pancreatic invasion. The active surgical management of AGC with pancreatic invasion is advisable, which can improve the survival of some patients.