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我院自1964年4月至1982年12月共收治Ⅰ期胃癌14例,行R_2术8例,胃大部分切除6例,其5、10年生存率相似。Ⅱ期胃癌115例,行R_2术64例,胃大部分切除51例,其5年生存率相似,10年生存率R_2术似较高。就理论而言,Ⅰ期胃癌应无淋巴结转移,则胃大部分切除已达治疗目的,但临床实践中必然存在肉眼判别误差,第Ⅰ站淋巴结是否有转移难以判断,故术中认为属Ⅰ期病例,行R_1术多可达到治疗目的。Ⅱ期病例应无第Ⅱ站淋巴结转移,故作R_1术即可达到治疗目的。但Ⅱ期病例中,多数病灶已侵及肌层甚至浆膜层,则第Ⅱ站淋巴结转移可达30％以上,即部分病例已属Ⅲ期,临床实践中Ⅱ、Ⅲ期肉眼实难判断,故术中认为属Ⅱ期病例,应行R_2术或选择性R_3术较合理。
Fourteen cases of stage I gastric cancer were treated in our hospital from April 1964 to December 1982. Eight patients underwent R_2 and 6 underwent major gastrectomy. The 5-year and 10-year survival rates were similar. There were 115 patients with stage II gastric cancer, 64 with R_2 surgery, and 51 with major gastrectomy. The 5-year survival rate was similar, and the 10-year survival rate R_2 was higher. Theoretically speaking, stage I gastric cancer should have no lymph node metastasis, then most of the resection of the stomach has achieved therapeutic goals, but in clinical practice there must be a naked eye discriminating error. It is difficult to judge whether there is metastasis in the first station lymph node, so it is considered to belong to stage I during operation. In cases, R_1 surgery can achieve therapeutic goals. Phase II cases should have no lymph node metastasis at site II, so R_1 surgery can achieve therapeutic goals. However, in stage II cases, most of the lesions have invaded the muscularis and even the serosa, the lymph node metastasis of the second site can reach more than 30%, that is, some cases are already in stage III. In stage II and III of clinical practice, it is difficult to judge with naked eyes. Therefore, it is reasonable to consider R2 surgery or selective R3 surgery as a stage II case.