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目的 探讨胃上部癌行根治性全胃切除与近端胃切除的治疗效果。方法 回顾分析本院 1980～ 1994年收治的 2 44例胃上部癌病人 ,通过并发症、生存率等方面对二种术式进行对比。结果 两种术式Ⅰ、Ⅱ期病人 3、5年生存率相似 (P >0 .0 5 ) ,Ⅲ期病人全胃切除组优于近切组 ,3年生存率提高了 2 2 2 % ,P <0 .0 5 ,差异有显著意义。Ⅳ期病人如远处无转移应根据病人状态行全胃加联合脏器切除 ,或姑息性手术。结论 对于胃上部癌的手术 ,应根据病期、肿瘤大小、浆膜受累程度、第 5、6组淋巴结转移情况来选择合理术式。两种术式常见的并发症吻合口狭窄及胆汁返流通过强生吻合器的使用有一定预防作用。
Objective To investigate the therapeutic effects of radical total gastrectomy and proximal gastrectomy for upper stomach cancer. METHODS: A total of 244 upper stomach cancer patients admitted to our hospital from 1980 to 1994 were retrospectively analyzed. Two surgical procedures were compared by complications and survival rates. Results The three- and five-year survival rates of the two stages I and II patients were similar (P > 0.05). The total gastrectomy group III patients were better than the near-cut group, and the 3-year survival rate was increased by 222%. P <0. 0 5, the difference was significant. Patients with stage IV who do not have distant metastases should have a total stomach plus combined organ resection or palliative surgery based on patient status. Conclusions For the operation of upper stomach cancer, reasonable surgery should be selected according to the stage of disease, the size of the tumor, the extent of serosal involvement, and lymph node metastasis in groups 5 and 6. Two common surgical complications, anastomotic stenosis and bile reflux, have a preventive effect through the use of a strong stapler.