摘要目的 探讨胃切除方式对胃中部癌患者预后的影响.方法 回顾性分析1998年1月至2005年12月间福建医科大学附属协和医院收治的222例胃中部癌患者的临床资料,其中行开腹远端胃大部切除术66例(DG组),行开腹全胃切除术患者156例(TG组),比较两组患者术后5年的生存率.结果 DG组和TG组术后5年生存率分别为63.9％和49.8％,差异具有统计学意义(P＜0.05).但相比之下,TG组患者肿瘤更大、分期更晚、肿瘤位于小弯侧者居多(均P＜0.01).按TNM分期进行分层预后分析显示,相同病期的两组患者术后5年生存率的差异均无统计学意义(均P＞0.05).无论是以4 cm、5 cm还是6 cm作为近切缘截点,不同近切缘距离患者5年生存率的差异均无统计学意义(均P＞0.05).多因素预后分析显示,浸润深度、淋巴结转移和TNM分期是独立预后影响因素(均P＜0.05);而胃切除方式并不是独立预后因素(P＞0.05).结论 胃中部癌患者如果能够达到根治手术的要求,其预后不受胃切除方式的影响,行远端胃大部切除术是可行的.

abstractsObjective To investigate the impact of the extent of gastric resection on the prognosis of patients with middle one-third gastric cancer.Methods From January 1998 to December 2005,222 patients with middle one-third gastric cancer underwent D2 radical resection in the AffiliatedUnion Hospital,Fujian Medical University.Among them,66 underwent distal gastrectomy(DG group),while 156 underwent total gastrectomy(TG group).The 5-year survival rates were compared between two groups.The prognostic factors were evaluated by univariate and multivariate analyses.Results The 5-year survival rates of DG group and TG group were 63.9％ and 49.8％ respectively,with significant difference (P＜0.05).Nevertheless,compared to DG group,the tumors in TG group had bigger size,later TNM stage,and higher proportion of locating lesser curvature of stomach (all P＜0.01).Multivariate analysis revealed that invasion depth,lymph node metastasis and TNM classification were independent prognostic factors (all P＜0.05),but the extent of gastric resection was not(P＞0.05).Conclusion If curative resection can be performed,the long-term prognosis of patients with middle one-third gastric cancer is not affected by the extent of gastric resection,and distal gastrectomy is feasible.