局部进展期胃癌联合脏器切除术的临床分析（附93例报告）

摘要

目的探讨联合脏器切除术治疗局部进展期胃癌的临床疗效及预后。方法对我院2002年8月至2009年12月收治的93例局部侵犯周围脏器的进展期胃癌患者的临床资料进行回顾性分析。结果联合胰体尾及脾切除24例，脾切除17例，横结肠部分切除10例，左肝外叶切除10例，胆囊切除7例，膈肌部分切除5例，胰体尾及脾切除加横结肠部分切除5例，双侧卵巢切除5例，左肝外叶及横结肠切除4例，胰十二指肠切除3例，肾上腺切除2例，联合胰体尾、脾、左肝外叶、部分膈肌及左肾上腺切除1例。术前新辅助化疗25例（26.88%），术后病理肿瘤缓解分级评分：0级4例，1级6例，2级8例，3级5例，4级2例，缓解率为84.0%。术后并发症发生率为31.18%，死亡率为4.30%，1年、3年生存率分别为50.11%和26.12%。结论联合脏器切除术是治疗局部进展期胃癌有效的手段，可提高术后生存率。术前辅助化疗能在一定程度上提高手术切除率和术后生存率。%Objective To investigate clinical outcomes and prognosis for patients undergoing multiple organ resection to treat locally advanced gastric cancer. Methods We retrospectively analyzed 93 patients with locally advanced gastric cancer who underwent multi-ple organ resection in our hospital between January 2002 and December 2009. Results Of the 93 patients,24 underwent distal pan-createctomy and splenectomy;17,splenectomy;10,transverse colectomy;10,left hepatectomy;7,cholecystectomy;5,diaphragmatic re-section;5,splenectomy;5,distal pancreatectomy plus transverse colectomy;5,double oopherectomy;4,left hepatectomy plus transverse colectomy;3,pancreatoduodenectomy;2,auxiliary adrenalectomy;and 1,distal pancreatectomy,splenectomy,left hepatectomy,diaphrag-matic resection and auxiliary adrenalectomy.The overall preoperative neoadjuvant chemotherapy rate was 25/93(26.88%),and tumor release grades were distributed as follows:grade 0,4 patients;grade 1,6 patients;grade 2,8 patients;grade 3,5 patients;and grade 4,2 patients.Postoperative morbidity and mortality rates were,respectively,29/93(31.18%)and 4/93(4.30%).The 1- and 3-year overall survival rates were 50.11% and 26.12%,respectively. Conclusions Multiple organ resection is an effective treatment for locally ad-vanced gastric cancer and it improves survival rates. Preoperative neoadjuvant chemotherapy improves survival and resection rates.