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目的:探讨进展期胃癌根治术的全胃切除联合脾胰体尾切除合理适应证与淋巴结转移等的相关性。方法:选取我院自1997年1月至2007年12月期间273例行全胃切除的胃癌根治术病人,比较全胃联合脾胰体尾切除组(切脾组)和单纯全胃切除(保脾组)之间在肿块大小、淋巴结转移、生长方式、Borrmann分型、癌灶距脾门距离、分化类型以及生存期等方面的差异。结果:切脾组病人5年生存率为31.8%,保脾组为35.4%,两组在5年生存率上无统计学差异(χ2=0.205,P>0.05),在生存曲线上两组间有统计学差异,保脾组明显优于切脾组(χ2=10.853,P<0.01)。切脾组和保脾组间4、10、11组淋巴结转移情况、肿块大小、分化程度、生长方式、Borrmann分型等方面差异有统计学意义(P<0.01)。第4组淋巴结有转移与第10、11组淋巴结有转移的病人相关性比较无统计学差异(P>0.05),但是第10、11组淋巴结有转移的12例病人中有11例第4组淋巴结转移。结论:胃癌根治术全胃切除时,肿块较大、分化较差、呈浸润性生长并4、10和11组淋巴结有转移应考虑联合脾胰体尾切除,但全胃联合脾胰体尾切除不一定延长胃癌病人生存期。
Objective: To investigate the correlation between gastrectomy combined with radical gastrectomy and lymph node metastasis in radical gastrectomy. Methods: 273 patients undergone total gastrectomy for radical gastrectomy in our hospital from January 1997 to December 2007 were enrolled in this study. Total gastrectomy combined with splenectomy group and splenectomy group were compared with simple total gastrectomy Spleen group) in the size of the tumor, lymph node metastasis, growth pattern, Borrmann classification, distance from the tumor spleen door, the type of differentiation and survival. Results: The 5-year survival rate was 31.8% in the splenectomy group and 35.4% in the spleen-preserving group. There was no significant difference in 5-year survival rate between the two groups (χ2 = 0.205, P> 0.05) There is a statistical difference, spleen protection group was significantly better than the splenectomy group (χ2 = 10.853, P <0.01). There were significant differences in lymph node metastasis, tumor size, differentiation degree, growth pattern, Borrmann classification among 4, 10 and 11 cases of splenectomy group and spleen preservation group (P <0.01). No significant difference was found in the correlation between lymph node metastasis in group 4 and patients with lymph node metastasis in groups 10 and 11 (P> 0.05), but 11 of the 12 patients with lymph node metastasis in group 10 and 11 had no correlation with group 4 Lymph node metastasis. Conclusions: Total gastrectomy with radical gastrectomy for gastric cancer has larger lumps, poorly differentiated tumors, infiltrative growth and lymph node metastasis in groups 4, 10 and 11. Does not necessarily extend the survival of gastric cancer patients.