摘要目的 探讨近端胃癌根治术后早期复发(2年内)的危险因素.方法 回顾性分析2000年1月至2006年5月年间天津医科大学附属肿瘤医院行根治性切除、且有完整随访资料的367例近端胃癌患者的临床资料,其中术后早期复发71例(19.3％).通过单因素和多因素分析来明确近端胃癌术后早期复发的危险因素.结果 早期复发危险因素的单因素分析结果显示,Borrmann分型(P＜0.01)、病理类型(P＜0.01)、浸润深度(P＜0.05)和阴性淋巴结数与近端胃癌早期复发有关(P＜0.05)；多因素分析显示,病理类型(P＜0.05)、浸润深度(P＜0.05)和阴性淋巴结数(P＜0.01)是近端胃癌早期复发的独立危险因素(均P＜0.05).早期复发患者的阴性淋巴结数为(8.4±7.2)枚,明显低于无早期复发者的(10.7±8.7)枚(P＜0.05).结论 对原发肿瘤浸润深度达T3以上、病理类型为腺鳞癌的近端胃癌患者,应适当扩大手术切除范围、积极行标准或扩大的淋巴结清扫,于术中或术后常规加行辅助治疗.

abstractsObjective To explore the risk factors for early recurrence (recurrence within 2 years) of proximal gastric cancer after radical resection.Methods The clinical data of 367 proximal gastric cancer patients who underwent radical resection in the Cancer Institute and Hospital of Tianjin Medical University between January 2000 and May 2006 were reviewed.Among them,there are 71 patients (19.3％) with early recurrence.Univariate analysis and multivariate analysis were applied to investigate risk factors for early recurrence.Results Univariate analysis showed that Borrmann type (P＜0.01),histology type(P＜0.01),depth of invasion(P＜0.05),negative lymph nodes count(P＜0.05) were risk factors for early recurrence of proximal gastric.On multivariate analysis,histology type(P＜0.05),depth of invasion (P＜0.05),negative lymph nodes counts (P＜0.05) were independent risk factors for early recurrence of proximal gastric cancer.Negative lymph nodes in early recurrence patients were 8.4±7.2,which were significantly less as compared to patients without early recurrence (10.7±8.7) (P＜0.05).Conclusion For T3 proximal gastric adenosquamous cancer, extended resection and lymphadenectomy should be considered.Intraoperative or postoperative adjuvant treatment should be administered as routine.