目的探讨根治性胃癌切除术后切缘残瘤癌（下称切缘阳性）的主要原因。方法采用前瞻性回顾的方法，总结了本院自１９７５年１月至１９９５年１２月间共行胃癌根治术５４９例，切缘阳性４６例，占８３８％，其中：①远端胃切除４６０例，切缘阳性３５例，占７６１％；②近端胃切除加全胃切除术共８９例，切缘阳性１１例，占１２３６％。并对癌细胞侵犯深度、胃周围淋巴结有无癌转移和胃周淋巴管有无癌栓与切缘阳性的关系加以分析。结果未按规范化行胃癌根治术；术前检查不充分；麻醉和切口选择不当是造成切缘阳性的主要原因。结论我们主张胃癌根治术应由专业的肿瘤外科医师执行，术前检查要充分，应选择合适的麻醉方式和切口。 Objective To investigate the main reason of resection margin cancer after radical gastrectomy (hereinafter referred to as positive margin). Methods A prospective review was used to summarize 549 cases of radical gastrectomy for gastric cancer in our hospital from January 1975 to December 1995. 46 positive margins were observed, accounting for 8  38%, of which: 1 distal gastrectomy In 460 cases, positive margin was 35 cases, accounting for 7  61%; 2 proximal gastrectomy plus total gastrectomy was performed in 89 cases, and positive margin was 11 cases, accounting for 12  36%. The relationship between the depth of invasion of cancer cells, the presence or absence of cancer metastasis in lymph nodes around the stomach, and the presence or absence of tumor emboli in the lymphatic vessels were positively correlated with the margin. The results did not follow the standardization of gastric cancer radical surgery; preoperative examination was inadequate; improper selection of anesthesia and incision is the main reason leading to positive margin. Conclusions We believe that radical gastrectomy for gastric cancer should be performed by a professional oncologist. Preoperative examination should be adequate and appropriate anesthesia and incisions should be selected.