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目的了解不同区域腹膜种植胃癌临床病理特征及手术治疗对预后的影响。方法中山大学附属第一医院1994年8月至2006年3月共收治107例胃癌伴单纯腹膜种植,分析其临床病理参数并评估外科治疗对预后的影响。依种植区域分为结肠上区(SC)、结肠下区(IC)、全腹膜种植(TPS)3组。结果TPS组的年龄较单区域种植组小(P<0.05),SC和TPS组发生脏器侵犯的比例高于IC组(P<0.05)。病灶全切除、病灶姑息性切除较旁路或造口手术、探查活检术的存活期明显延长(P<0.05),手术方式为独立预后因素。淋巴结清扫组较未清扫组的存活期显著延长(P<0.01)。全胃切除(TG)、部分胃切除(PG)较未切胃(NG)的存活期明显延长(P<0.05)。结论低龄胃癌病人容易发生远处腹膜种植,结肠上区和全腹腔种植者易发生局部脏器浸润,病灶全切除和姑息性切除、适度淋巴清扫可提高病人存活期,在满足病灶切除条件下,应首选部分胃切除而不是全胃切除。
Objective To investigate the clinicopathological characteristics of gastric cancer and the effects of surgical treatment on the prognosis of peritoneal implanted gastric cancer in different regions. Methods The First Affiliated Hospital of Sun Yat-sen University from August 1994 to March 2006 treated a total of 107 cases of gastric cancer with simple peritoneal implantation, analysis of its clinical and pathological parameters and assess the impact of surgical treatment on prognosis. According to the planting area is divided into upper colon (SC), colon (IC), total peritoneal implantation (TPS) 3 groups. Results The age of TPS group was smaller than that in monoculture group (P <0.05). The incidence of organ invasion in SC and TPS group was higher than that in IC group (P <0.05). Total resection of the lesion, palliative resection of the lesion compared with bypass or ostomy, survival time of exploration biopsy was significantly prolonged (P <0.05), and the surgical method was independent prognostic factor. The survival of lymph node dissection group was significantly longer than that of the non-emptied group (P <0.01). Total gastrectomy (TG), partial gastrectomy (PG) than the non-gastric (NG) survival was significantly longer (P <0.05). Conclusion Patients with gastric cancer at the younger age are prone to distant peritoneal implantation. Local colon infiltration, partial resection and palliative resection are easy to occur in the upper colon and whole abdominal cavity growers. Moderate lymphadenectomy may improve the survival of the patients. Under the conditions of excision of the lesion, Partial gastrectomy should be preferred rather than total gastrectomy.