目的　为晚期胃癌合理选择非治愈性手术方式提供依据。方法　按病情程度、生物学行为分组 ,评价5 78例行非治愈性手术的Ⅲb、Ⅳ期胃癌病例手术后效果。结果　姑息切除、改道及探查手术三组间 ,手术越大并发症越多 (P <0 0 5 ) ,手术死亡率差别不大 (P >0 0 5 )。术后 2年生存率姑息切除明显优于改道和探查组 (P<0 0 5 )。无腹膜、肝脏及远处转移组及有腹腔转移、无肝转移组姑息切除术后各年生存率差异均无显著意义 (P>0 0 5 ) ,有肝转移组术后生存率降低 ,随肝转移程度愈趋明显 (P <0 0 5 )。姑息切除术后 2年生存率 ,限局型明显优于浸润型 (2 0 0 %比 9 5 % ,P <0 0 5 )。远端、近端及全胃姑息切除术后生存率差异无意义 (P >0 0 5 )。结论　姑息切除效果优于不切除。腹膜转移不影响姑息切除术后生存率 ,肝转移手术效果不良 ,H3 者切除意义不大 ,限局型胃癌应优先考虑切除。全胃及近端胃姑息切除与远端胃切除同样有效 Objective To provide the basis for the rational choice of non-curative surgery for advanced gastric cancer. Methods According to the degree of illness and biological behaviors, the postoperative results of 5 78 cases of stage IIIb and IV gastric cancer undergoing non-curative surgery were evaluated. Results The complications of palliative resection, diversion and probing were significantly higher among the three groups (P < 0.05) and the surgical mortality was not significantly different (P > 0.05). Palliative resection after 2-year survival was significantly better than diversion and probing (P < 0.05). There was no significant difference in survival rates between peritoneal, hepatic and distant metastasis groups and peritoneal metastases and non-hepatic metastasis group after palliative resection (P>0.05). The survival rate of patients with hepatic metastasis decreased, followed by The degree of liver metastasis became more obvious (P < 0.05). The 2-year survival rate after palliative resection was significantly better than that of the infiltrative type (20% vs. 95%, P < 0.05). The difference in survival rates after distal, proximal, and total palliative resection was not significant (P > 0.05). Conclusion Palliative resection is better than no resection. Peritoneal metastasis did not affect the survival rate after palliative resection. The effect of liver metastasis was poor. H3 resection had little significance. Restriction of local gastric cancer should be given priority. Palliative resection of the entire stomach and proximal stomach is as effective as distal gastrectomy