摘要目的 比较胃癌Krukenberg瘤与盆腔腹膜种植的临床病理特征,分析手术对预后的影响.方法 1994年8月至2006年3月共收治女性胃癌伴盆腔转移患者39例,其中Krukenberg瘤18例,无Krukenberg瘤的盆腔腹膜种植21例,比较两组的临床病理特征,分析手术对总体病例预后的影响.结果 胃癌Krukenberg瘤和盆腔腹膜种植患者的年龄、肿瘤部位、大小、肝转移率、脏器侵犯率、浸润深度、阳性淋巴结数、组织类型、分化程度、Borrmann分型、癌胚抗原间等差异均无显著性意义(P>0.05).胃癌Krukenberg瘤的P3型腹膜种植率(44.4%)显著低于盆腔腹膜种植患者(85.7%)(P<0.05).胃癌Krukenberg瘤的病灶切除率(77.8%)、联合脏器切除率(55.6%)均显著高于盆腔腹膜种植者(38.0%、23.8%)(P<0.05).总体病例的平均生存期为12.6个月.胃癌Krukenberg瘤和盆腔腹膜种植病例的平均生存期分别为20.5、9.7个月(P<0.05).总体病例接受病灶全切除、病灶姑息切除和非病灶切除术的平均生存期分别为19.9、12.5、5.7个月,病灶切除能显著延长患者生存期(P<0.05).姑息手术、盆腔腹膜种植、P3型腹膜种植、肝转移、脏器侵犯、全胃癌、腹水为预后不良因素.结论 较无Krukenberg瘤的盆腔腹膜种植病例相比,胃癌Krukenberg瘤的腹膜扩散程度更为局限、手术切除率更高、预后更好,病灶切除对改善预后有益.

abstractsObjective To compare the clinicopathological characters and operative prognosis of gastric cancer complicated with Krekenberg tumor and with pelvic peritoneal dissemination. Methods Thirty- nine female eases of gastric carcinoma with pelvic metastasis were treated operated on between August 1994 and March 2006. Among them, 18 cases were complicated with Krukenberg tumor and 21 cases with pelvic peritoneal dissemination. The clinicopathological characters in the two groups were recorded and compared and the operative prognosis were analyzed. Results There was no significant difference in age, tumor location and size, hepatic metastasis, organic encroachment, infiltration degree, positive lymph nodes, differentiated degree, tissue typing, Borrmann typing, value of carcinoembryonic antigen between the two groups (P>0.05). The rate of P3 (peritoneal dissemination) in the cases of Krukenberg tumor (44.4%) was significantly lower than that in pelvic peritoneal dissemination group (85.7%) (P<0.01), whereas the focal resection rate (77.8%) and multi-organ dissection rate (55.6%) were significantly higher than in pelvic peritoneal dissemination (38.0%, 23. 8% ) (P<0.05). The mean survival of all cases was 12. 6 months. The mean survival in the patients with Krukenberg tumor and pelvic peritoneal dissemination was 20. 5,15.0 months, respectively (P<0.05). The mean survival of total focal resection, palliative focal resection, non-focal resection was 19.9, 12.5 and 5.7 months, respectively (P<0.01). Non-focal resection, pelvic peritoneal dissemination, P3 of peritoneal implantation, hepatic metastasis, organic encroachment, total gastric cancer were unfavorable prognosis factors for all cases. Conclusions Compared with pelvic peritoneal dissemination, the gastric cancer with Krukenberg tumor is associated with more limited peritoneal dissemination,higher resection rate and better prognosis. Focal resection can improve the prognosis.