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目的探讨全胃切除及系统的淋巴结清扫治疗进展期贲门癌的临床价值。方法对387例进展期贲门癌患者施行全胃切除及D2以上的淋巴结清扫,分析贲门癌浸润胃壁深度与淋巴结转移、淋巴转移及清扫淋巴结数目与术后累积生存率的关系。结果本组贲门癌患者术后3年、5年累积生存率分别为47．3％、34．2％,pT3、pT4的贲门癌患者pN3转移率分别为4．8％、15．2％,并且随着淋巴结转移数目的增加,3年、5年累积生存率明显下降(P<0．01、P<0．01),清扫15或30个以上淋巴结的贲门癌患者3年、5年累积生存率明显高于清扫少于15个淋巴结者(P<0．05、P<0．01)。本组贲门癌患者术后并发症发生率与病死率分别为14．2％、2．52％。结论对进展期贲门癌患者只要条件许可应施行根治性全胃切除(D2+术式),必要时联合脾、胰体尾整块切除,以提高生存质量和延长生存期。
Objective To investigate the clinical value of total gastrectomy and systemic lymph node dissection in the treatment of advanced cardia cancer. Methods Total gastrectomy and lymph node dissection over D2 were performed in 387 patients with advanced cardia carcinoma. The relationship between the depth of gastric wall invasion and lymph node metastasis, lymphatic metastasis and the number of lymphatic nodes and the cumulative survival rate were analyzed. Results After 3 years of operation, the 5-year cumulative survival rates of cardia cancer patients were 47.3% and 34.2% respectively. The pN3 metastasis rates of gastric cardia cancer patients with pT3 and pT4 were 4.8% and 15.2% And as the number of lymph node metastases increased, the 5-year cumulative survival rate decreased significantly at 3 years (P <0.01, P <0.01). Cardiac cancer patients with 15 or more lymph nodes dissected for 3 years and 5 years accumulated Survival rate was significantly higher than less than 15 lymph node dissection (P <0.05, P <0.01). The incidence of postoperative complications and mortality in patients with cardia cancer were 14.2%, 2.52%. Conclusions Radical total gastrectomy (D2 + operation) should be performed for patients with advanced cardia cancer as long as conditions permit, combined with splenic and pancreatic body tail block resection if necessary to improve quality of life and prolong survival.