摘要目的 研究术后切缘状态对术中冰冻切缘阳性进展期胃癌预后的作用,探讨术中冰冻切缘阳性的治疗选择.方法 回顾性分析1996年1月至2008年12月64例进展期胃癌术中冰冻诊断切缘阳性患者.比较术后切缘状态为阳性与阴性两组的生存曲线,并对预后影响因素进行单因素和多因素Cox回归分析.结果 切缘阳性组中位生存时间为17.0个月(95％ CI:11.6 ～22.4),切缘阴性组为23.0个月(95％ CI:20.5 ～25.5)(p=0.045)；切缘状态在多因素Cox回归分析中无统计学意义(P＞0.05).在D2淋巴结清扫的亚组中,切缘阳性组中位生存时间为17.0个月(95％ CI:12.0 ～22.0),切缘阴性组为24.0个月(95％ CI:19.8 ～28.1)；多因素Cox回归分析进一步确认切缘状态为独立的预后影响因素.结论 术中切缘阳性的进展期胃癌再次切除后获得阴性切缘能改善预后,充分衡量手术风险的基础上应尽可能再次切除以获得阴性切缘；根治性胃癌切除术应常规行术中冰冻切片检查评估切缘状况.

abstractsObjectives To investigate prognostic effect of postoperative resection-margin status for intraoperatively positive resection margin in advanced gastric cancer and discuss the treatment choice for intraoperatively positive resection margins.Methods A retrospective study was investigated in 64 advanced gastric cancer patients with positive resetion margin after potentially curative resection.The survival between 50 patients who was reexcised to a negative resection margin (NR group) and 14 patients who were left with positive resetion margin (PR group) was compared. Prognostic factors werc analyzed using univariate and multivariate Cox regression model analysis.Results The median survival in the PR group was 17.0 months (95％CI:11.6-22.4) as compared with 23.0 months (95％ CI:20.5-25.5)in the NR group (P =0.045).However,resection-margin status lost significance on multivariate analysis.In the subgroup of D2 lymphadenectomy,the median survival in the PR group and NR group were 17.0 months (95％ CI:12.0-22.0) and 24.0 months (95％ CI:19.8-28.1 ) respectively;multivariate analysis further identified resection margin status as an independent prognostic factor. Conclusions Reexcision for intraoperatively positive margin to negative margin improves the prognosis of the patients with advanced gastric cancer,and reexcision is the first choice when intraoperative frozen section detects a positive margin. Routine frozen section of resection margin should be mandatory in all advanced gastric cancer undergoing potentially curative surgery.