摘要目的 探讨胃体癌合理的手术切除范围.方法 回顾性分析2001年1月至2006年12月收治的145例行根治性手术的胃体癌患者的临床病理资料,对比分析全胃切除患者与远端胃次全切除患者的临床病理及预后差异.结果 145例胃体癌患者中,行全胃切除者98例(全胃切除组),远端胃切除者47例(远端胃切除组)；2组在肿瘤最大径(分别为7.2、4.5 cm,t=4.724,P =0.000)、浸润深度(x2=9.599,P=0.022)、淋巴结转移(x2=10.738,P=0.013)及TNM分期(x2=12.724,P =0.005)等方面差异均有统计学意义；全胃切除组的5年生存率为25.5％,低于远端胃切除组(63.8％,x2=11.707,P=0.000);而TNM各分期中两组的5年生存率差异并无统计学意义；TNM分期(P =0.044)与肿瘤分化程度(HR=1.834,95％CI:1.073 ～3.135,P=0.027)是胃体癌的独立预后因素.结论 胃体癌患者中远端胃次全除的总生存率好于全胃切除,但是在各临床分期中并无差异；而手术方式也并非胃体癌的独立预后因素,因此在能保证根治切除的情况下远端胃次全切除对于胃体癌患者更为合适.

abstractsObjective To discuss the reasonable surgery for gastric body cancer.Methods From January 2001 to December 2006,the clinicopathological data of 145 patients with a tumor in the middle third of the stomach underwent radical gastric resection were analyzed retrospectively.We conducted comparative analysis for the differences in clinicopathological characteristics and prognosis between total gastrectomy (TG) and subtotal gastrectomy (STG).Results The 98 patients underwent TG,47 received STG.There were significant differences in aspects of tumor size,depth of tumor,nodal status and TNM stage between the 2 groups.Patients with more advanced cancer were more likely to receive TG.The 5-year survival rate for TG was lower (25.5％) than STG (63.8％) (x2 =11.707,P =0.000).However,if tumor stages were stratified,there was no significant difference in the 5-year survival rate.TNM stage (P =0.044) and histologic type (HR =1.834,95％ CI: 1.073-3.135,P =0.027) were independent prognostic factors.Conclusions The overall survival rate of STG for gastric cancer in the middle third of the stomach is better than that of TG.If the radical resection margin can be obtained for gastric body carcinoma,STG is considered instead of TG.