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目的探讨基层医院开展胃癌根治术的合理手术方式。方法对59例施行胃癌根治术病例中获得随访的46例患者的手术适应证、手术方式和范围及消化道的重建方式、术后并发症的发生率及生存情况进行总结。结果在获得随访的46例施行全胃切除的胃癌根治术后病人中,行D2、D2+、D3、D4淋巴结清除术的患者术后并发症发生率分别为16.7%、15%、33.3%、100%;3年生存率分别为100%、100%、16.7%、0;5年生存率分别为77.8%、80%、0、0。结论在基层医院,全胃切除加D2或D2+淋巴结清除根治术是治疗进展期胃癌的安全、合理术式,盲目地追求D3或D4术式是危险的,也是不切合实际的。
Objective To explore the reasonable operation method of radical gastrectomy in primary hospitals. Methods The surgical indications, surgical modalities and range of 46 patients who underwent radical gastrectomy for gastric cancer were retrospectively analyzed. The methods of reconstructing the digestive tract, the incidence of postoperative complications and their survival were summarized. Results Among the 46 patients who undergone total gastrectomy for radical gastrectomy, the incidences of postoperative complications in patients with D2, D2 +, D3, D4 lymph node dissection were 16.7%, 15%, 33.3%, 100 %; 3-year survival rates were 100%, 100%, 16.7%, 0; 5-year survival rates were 77.8%, 80%, 0,0. Conclusion Total gastrectomy combined with radical gastrectomy plus D2 or D2 lymph node dissection is a safe and rational method for the treatment of advanced gastric cancer. It is also not practical and feasible to blindly pursue the D3 or D4 procedure.