T_(4a)期胃癌患者行微创手术后的生存状况与长期效果研究
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摘要
目的探究T4a期胃癌患者行微创手术后的生存状况与长期效果。方法回顾性分析2010年1月-2013年1月该院收治的93例T4a期胃癌患者的临床资料,所有患者均行腹腔镜T4a期胃癌根治术治疗,术后经门诊、电话等方式进行随访,其中5例患者失访,以未失访的88例患者作为研究对象。分析患者5年生存状况,其中49例患者存活为存活组,39例患者死亡为死亡组。对T4a期胃癌患者行微创手术后死亡相关因素进行单因素和Logistic多因素分析。结果术后5年内48.86%(43例)患者无病生存;6.82%(6例)患者带瘤生存,44.32%(39例)患者死亡,其中39.77%(35例)患者因复发或转移死亡。单因素分析结果显示,肿瘤直径、肿瘤部位、联合脏器切除、肿瘤N分期、Lauren分型、淋巴结转移率、淋巴结转移范围、淋巴结转移数目与T4a期胃癌患者行微创手术后死亡有密切相关性(P<0.05)。Logistic多因素分析结果显示,联合脏器切除、肿瘤N2分期、淋巴结转移率>40%、淋巴结转移范围大、淋巴结转移数目多为T4a期胃癌患者行微创手术后死亡的危险因素(P<0.05)。结论 T4a期胃癌患者行微创手术后5年生存状况不佳,联合脏器切除、肿瘤N2分期、淋巴结转移率>40%、淋巴结转移范围大、淋巴结转移数目是其术后死亡的危险因素,应对此类患者加强监测,以改善预后。
Objective To investigate the survival and long-term effects of minimally invasive surgery for patients with T4 a gastric cancer.Methods The clinical data of 93 cases of T4 a gastric cancer treated from January 2010 to January 2013 were retrospectively analyzed.All the patients underwent laparoscopic T4 a radical gastrectomy and followed up by clinic and telephone after surgery.During the follow-up period,5 patients were lost to follow-up,and the other 88 patients who were not lost as study objects.The 5-year survival status of the patients was analyzed.Among them,49 patients survived in the survival group and 39 patients died in the death group.The univariate and Logistic multivariate analysis of the related factors of death after minimally invasive surgery in patients with T4 a gastric cancer were made.Results Within 5 years postoperatively,48.86%(43 patients) had disease-free survival,6.82%(6 patients) had tumor survival,44.32%(39 patients) died,and 39.77%(35 patients) died of relapse or metastasis.Univariate analysis showed that tumor diameter,location,combined organ resection,tumor N staging,Lauren classification,lymph node metastasis,lymph node metastasis range,number of lymph node metastasis,and T4 agastric cancer patients were closely related to death after minimally invasive surgery(P<0.05).Logistic multivariate analysis showed that combined organ resection,tumor N2 stage,lymph node metastasis rate>40%,lymph node metastasis range,and lymph node metastasis were mostly risk factors for death after T4 a-stage gastric cancer patients underwent minimally invasive surgery(P<0.05).Conclusions The survival of patients with T4 a gastric cancer after 5 years of minimally invasive surgery is not good,combined organ resection,tumor N2 stage,lymph node metastasis rate>40%,lymph node metastasis range,the number of lymph node metastasis is a risk factor for its death.The monitoring of such patients should be strengthened to improve the prognosis.
Objective To investigate the survival and long-term effects of minimally invasive surgery for patients with T4 a gastric cancer.Methods The clinical data of 93 cases of T4 a gastric cancer treated from January 2010 to January 2013 were retrospectively analyzed.All the patients underwent laparoscopic T4 a radical gastrectomy and followed up by clinic and telephone after surgery.During the follow-up period,5 patients were lost to follow-up,and the other 88 patients who were not lost as study objects.The 5-year survival status of the patients was analyzed.Among them,49 patients survived in the survival group and 39 patients died in the death group.The univariate and Logistic multivariate analysis of the related factors of death after minimally invasive surgery in patients with T4 a gastric cancer were made.Results Within 5 years postoperatively,48.86%(43 patients) had disease-free survival,6.82%(6 patients) had tumor survival,44.32%(39 patients) died,and 39.77%(35 patients) died of relapse or metastasis.Univariate analysis showed that tumor diameter,location,combined organ resection,tumor N staging,Lauren classification,lymph node metastasis,lymph node metastasis range,number of lymph node metastasis,and T4 agastric cancer patients were closely related to death after minimally invasive surgery(P<0.05).Logistic multivariate analysis showed that combined organ resection,tumor N2 stage,lymph node metastasis rate>40%,lymph node metastasis range,and lymph node metastasis were mostly risk factors for death after T4 a-stage gastric cancer patients underwent minimally invasive surgery(P<0.05).Conclusions The survival of patients with T4 a gastric cancer after 5 years of minimally invasive surgery is not good,combined organ resection,tumor N2 stage,lymph node metastasis rate>40%,lymph node metastasis range,the number of lymph node metastasis is a risk factor for its death.The monitoring of such patients should be strengthened to improve the prognosis.
引文
[1]孟燕,曹凤军,陈萍.补中益气汤加减联合化疗治疗胃癌术后50例[J].环球中医药,2015,8(8):995-997.[1]MENG Y,CAO F J,CHEN P.Treatment of 50 cases of postoperative gastric cancer with Buzhong Yiqi Decoction combined with chemotherapy[J].Global Traditional Chinese Medicine,2015,8(8):995-997.Chinese
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[6]彭建军,吴恺明,袁玉杰,等.不同部位胃癌患者的临床病理特点和预后[J].中华普通外科杂志,2015,30(2):92-95.[6]PENG J J,WU K M,YUAN Y J,et al.Clinicopathologic features and survivals of postoperative gastric carcinoma patients by different tumor locations[J].Chinese Journal of General Surgery,2015,30(2):92-95.Chinese
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[9]张鹏,徐岩,郭江宁,等.国际抗癌联盟-美国癌症联合委员会第7版与第6版TNM分期中的p T分期对胃癌患者预后的预测价值[J].中华肿瘤杂志,2015,17(3):190-194.[9]ZHANG P,XU Y,GUO J N,et al.Comparison of the predictive value of the sixth and seventh edition TNM p T classifications in prognosis for gastric cancer[J].Chinese Journal of Oncology,2015,17(3):190-194.Chinese
[10]李小宝,訾永宏,曹波,等.淋巴结转移率对检出不同淋巴结数量的胃癌患者预后的评价价值[J].中华普通外科杂志,2017,32(7):577-580.[10]LI X B,ZI Y H,CAO B,et al.Metastatic lymph node ratio and prognosis of gastric cancer at different lymph node numbers examined[J].Chinese Journal of General Surgery,2017,32(7):577-580.Chinese
[11]张帆,郝迎学,唐波,等.不同浆膜受侵犯面积胃癌患者行腹腔镜胃癌根治术对腹腔微转移的影响[J].中华消化外科杂志,2015,14(5):400-404.[11]ZHANG F,HAO Y X,TANG B,et al.Effects of laparoscopic radical gastrectomy on the peritoneal micrometastases of gastric cancer in patients with serosal invasion[J].Chinese Journal of Digestive Surgery,2015,14(5):400-404.Chinese
[12]王德华,吾建香,严志龙,等.远端胃癌患者行微创手术结合三角吻合的长期预后研究[J].中国内镜杂志,2017,23(11):5-9.[12]WANG D H,WU J X,YAN Z L,et al.Long-term prognosis of patients with distal gastric cancer underwent minimally invasive surgery combined with delta-shaped anastomosis[J].China Journal of Endoscopy,2017,23(11):5-9.Chinese
[2]KUNISAKI C,MAKINO H,KIMURA J,et al.Application of reduced-port laparoscopic total gastrectomy in gastric cancer preserving the pancreas and spleen[J].Gastric Cancer,2015,18(4):868-875.
[3]张尊庶.腹腔镜D2胃癌根治术的疗效及并发症分析[J].中华普外科手术学杂志:电子版,2017,11(2):150-153.[3]ZHANG Z S.Efficacy and complications of laparoscopic D2 radical gastrectomy for gastric cancer[J].Chinese Journal of Operative Procedures of General Surgery:Electronic Edition,2017,11(2):150-153.Chinese
[4]BEN-DAVID K,TUTTLE R,KUKAR M,et al.Laparoscopic distal,subtotal gastrectomy for advanced gastric cancer[J].Journal of Gastrointestinal Surgery,2015,19(2):369-374.
[5]胡洪亮.益气健脾抗癌汤联合化疗治疗胃癌41例[J].环球中医药,2016,9(8):996-998.[5]HU H L.Yiqi Jianpi Kangai Decoction combined with chemotherapy in treating 41 cases of gastric cancer[J].Global Traditional Chinese Medicine,2016,9(8):996-998.Chinese
[6]彭建军,吴恺明,袁玉杰,等.不同部位胃癌患者的临床病理特点和预后[J].中华普通外科杂志,2015,30(2):92-95.[6]PENG J J,WU K M,YUAN Y J,et al.Clinicopathologic features and survivals of postoperative gastric carcinoma patients by different tumor locations[J].Chinese Journal of General Surgery,2015,30(2):92-95.Chinese
[7]SUGITA H,KOJIMA K,INOKUCHI M,et al.Long-term outcomes of laparoscopic gastrectomy for gastric cancer[J].Journal of Surgical Research,2015,193(1):190-195.
[8]周军,侯军丽,李剑辉,等.根治性联合脏器切除在复发性胃癌治疗中的应用价值[J].中华胃肠外科杂志,2016,19(3):292-295.[8]ZHOU J,HOU J L,LI J H,et al.Application value of combined organ radical resection in patients with recurrent gastric cancer[J].Chinese Journal of Gastrointestinal Surgery,2016,19(3):292-295.Chinese
[9]张鹏,徐岩,郭江宁,等.国际抗癌联盟-美国癌症联合委员会第7版与第6版TNM分期中的p T分期对胃癌患者预后的预测价值[J].中华肿瘤杂志,2015,17(3):190-194.[9]ZHANG P,XU Y,GUO J N,et al.Comparison of the predictive value of the sixth and seventh edition TNM p T classifications in prognosis for gastric cancer[J].Chinese Journal of Oncology,2015,17(3):190-194.Chinese
[10]李小宝,訾永宏,曹波,等.淋巴结转移率对检出不同淋巴结数量的胃癌患者预后的评价价值[J].中华普通外科杂志,2017,32(7):577-580.[10]LI X B,ZI Y H,CAO B,et al.Metastatic lymph node ratio and prognosis of gastric cancer at different lymph node numbers examined[J].Chinese Journal of General Surgery,2017,32(7):577-580.Chinese
[11]张帆,郝迎学,唐波,等.不同浆膜受侵犯面积胃癌患者行腹腔镜胃癌根治术对腹腔微转移的影响[J].中华消化外科杂志,2015,14(5):400-404.[11]ZHANG F,HAO Y X,TANG B,et al.Effects of laparoscopic radical gastrectomy on the peritoneal micrometastases of gastric cancer in patients with serosal invasion[J].Chinese Journal of Digestive Surgery,2015,14(5):400-404.Chinese
[12]王德华,吾建香,严志龙,等.远端胃癌患者行微创手术结合三角吻合的长期预后研究[J].中国内镜杂志,2017,23(11):5-9.[12]WANG D H,WU J X,YAN Z L,et al.Long-term prognosis of patients with distal gastric cancer underwent minimally invasive surgery combined with delta-shaped anastomosis[J].China Journal of Endoscopy,2017,23(11):5-9.Chinese