单吉贤 陈峻青 王舒宝 徐惠绵 刘庆华 陈波 110001 沈阳，中国医科大学第一临床学院肿瘤科 中华肿瘤杂志 1999 0 21 6


    关键词：胃肿瘤/外科学；胃切除术；预后 期刊 zhzlzz 0 临床应用 fur -->


    

【摘要】 目的 使胃癌手术根治度的判定标准具体客观，对胃癌手术预后的判断具有可靠性和可信性。方法 采用日本胃癌规约12版中对胃癌手术根治度划为A、B、C的标准，对1980年12月～1990年12月间手术切除的533例胃癌根治度与预后的关系进行评价。结果 A根治度157例，B根治度209例，C根治度167例，其5年生存率分别为80.9%、34.9%和9.0%。在B根治度中，淋巴结清除站数>淋巴结转移站数(D>N)的5年生存率为48.0%，D=N为22.4%。二者差异有显著性(P<0.05)。在根治性胃切除时意外发生切缘癌残留，A、B根治度下降至C根治度者分别为6.0%和12.2%。结论 胃癌淋巴结清除的站数应大于淋巴结转移的站数，即D>N。术中应检查切除胃标本切缘距肿瘤缘的距离是否充分，以防止胃切缘癌残留。

Relationshipbetween extent of tumor resection and prognosis: an evaluation in 533 cases of gastriccancer

SHAN Jixian, CHEN Junqing, WANG Shubao, et al. Department of Oncology,First Affiliated Hospital, China Medical University, Shenyang, 110001

【Abstract】 Objective To evaluate prognosisof patients with stomach cancer based on the extent of tumor resection. Methods Fivehundred and thirty-three cases of gastric cancer resected from 1980 through 1990 weredivided into 3 categories A, B, and C, in the order of decreasing completeness of tumorresection as set forth in the 12^th edition of “Rules for Gastric Cancer inJapan”. Results There were 157 cases in category A, 209 cases incategory B and 167 cases in category C. Their survival rate was 80.9%, 34.9%, and 9%,respectively. In category A and B, the depth of tumor invasion and lymph node metastasiswere the major factors affecting survival rate. In the presence of lymph node metastasis,prognosis was dependent on which station (D₁ ～D₃ ) of lymph nodesdissected. In category B, if dissection covered D₃ but metastasis was limitedto Ⅰ or Ⅱ, the 5-year survival rate was 48%; if lymph node dissection performed waslimited to the same station of lymph nodes where metastasis occurred, the 5-year survivalrate dropped to 22.4% (P<0.05). In case cancer left over at the cutting edge, thecompleteness of resection might drop from category A or B to C, and the 5-year survivalrate correspondingly decreased to 6% and 12.2%, respectively. Conclusion Inorder to ensure completeness of tumor resection, lymph node station dissected should befarther than that with metastasis, and the distance between the tumor and the cutting edgeshould be long enough to prevent residual tumor left behind.

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