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目的探讨胃癌患者肝转移和腹膜扩散的相关临床病理因素和近远期预后以及姑息性手术对预后的影响。方法回顾性分析1994年8月至2005年7月间胃癌数据库资料中792例患者的临床病理资料和随访结果。结果本组患者肿瘤穿透浆膜、淋巴结转移、肝转移、全胃癌、未分化癌、BorrmannⅣ型、女性患者因素与腹膜扩散相关,而BorrmannⅣ型、淋巴结转移、腹膜扩散与胃癌肝转移相关(P＜0．05)。肝转移患者1年生存率低于腹膜扩散患者(P＜0．05)；而3、5年生存率两者差异无统计学意义(P＞0．05)。腹膜扩散组中姑息性切除术患者1年生存率高于旁路手术/喂食性造口术和剖腹探查患者(P＜0．05)；而肝转移患者3种手术者1、3、5年生存率比较,差异无统计学意义(P＞0．05)。结论有肝转移的胃癌患者近期预后比腹膜扩散患者差；姑息性切除术可改善腹膜扩散胃癌患者的近期生存率,而对肝转移患者影响不明显。
Objective To investigate the clinical and pathological factors related to liver metastasis and peritoneal diffusion in patients with gastric cancer and its prognosis as well as the impact of palliative surgery on prognosis. Methods The clinical pathological data and follow-up results of 792 patients from August 1994 to July 2005 in the database of gastric cancer were retrospectively analyzed. Results There was a correlation between peritoneal diffusion and peritoneal diffusion in patients with tumor penetrating serosal metastasis, lymph node metastasis, hepatic metastasis, total gastric cancer, undifferentiated carcinoma, Borrmann type Ⅳ, and female patients. Borrmann type Ⅳ, lymph node metastasis, <0.05). The 1-year survival rate of patients with liver metastasis was lower than that of patients with peritoneal diffusion (P <0.05). There was no significant difference in the 3-year and 5-year survival rates between the two groups (P> 0.05). The 1-year survival rate of patients in peritoneal diffusion group was higher than that in bypass surgery / feeding ostomy and laparotomy (P <0.05). In the patients with liver metastasis, the one-year survival rate was 1, 3 and 5 years Survival rate, the difference was not statistically significant (P> 0.05). Conclusion The prognosis of gastric cancer patients with liver metastases is worse than that of patients with peritoneal diffusion. Palliative resection can improve the short-term survival rate of patients with peritoneal diffusion gastric cancer, but have no obvious effect on patients with liver metastasis.