65例远端胃切除胃癌根治术术后复发患者的情况分析

发布时间：2018-12-20 11:41

【摘要】：目的:通过分析远端胃切除胃癌根治术术后复发患者的情况,探讨胃癌手术治疗新的思考切入点。方法:收集2010年08月至2015年10月广西医科大学附属肿瘤医院收治的372例行远端胃切除胃癌根治术病人的病案,按纳入和排除标准,共有65例术后复发病人,回顾性分析患者的临床和病理等相关资料。包括患者的基本信息和可能影响复发转移发生部位和复发时间的相关因素,如性别、年龄、原发肿瘤部位、术前CEA、手术方式、消化道重建方式、原发肿瘤大小、组织学类型、分化程度、浸润深度、淋巴结转移情况、肿瘤病期等,分析病人复发转移发生的部位、复发时间等基本情况及其与各种相关因素之间的关系。计量资料采用均数±标准差(?X±S)表示。与远端胃切除胃癌根治术术后复发转移发生部位、复发时间相关因素的分析比较采用行×列表的卡方检验(Chi-Square Tests,检验)。P0.05表示差异具有统计学意义。结果:在372例病人中术后复发65例,总复发率17.5%,其中发生远处转移患者42例次,远处转移率为11.3%,占复发病人的64.6%;局部复发患者23例次,局部复发率为6.2%,占复发病人的35.4%。大部分患者在2年内出现复发转移,共49例次,大于两年的远期复发患者为16例次。本组病人中位复发时间为13个月(范围3-73个月),发生远处转移的中位时间为11.5个月(范围3-73个月),局部复发的中位时间为14个月(范围3-46个月)。统计分析结果提示N分期(P=0.006)、肿瘤病期(P=0.006)与术后复发转移发生部位具有显著相关性,肿瘤病期(P=0.011)与术后复发时间具有显著相关性,差异具有统计学意义,肿瘤病期越晚,发生远处转移及早期复发的可能性越大。而患者的手术方式、消化道重建方式、切缘距离等与术后复发转移发生部位、复发时间无显著相关性。结论:1.远端胃切除胃癌根治术术后患者复发转移发生部位主要以远处转移为主。2.胃癌根治术后患者以早期复发更常见,复发时间与肿瘤病期具有显著相关性,术后早期更应密切跟踪随访。3.胃癌手术治疗中更应重视术后远处转移复发的问题,在某些情况下,过分机械的强调近端切缘距离的做法有待进一步探讨。
[Abstract]:Objective: to analyze the recurrence of gastric cancer after distal gastrectomy, and to explore a new approach to the treatment of gastric cancer. Methods: from August 2010 to October 2015, 372 patients with distal gastrectomy and radical gastrectomy were collected from the affiliated Cancer Hospital of Guangxi Medical University. According to the criteria of inclusion and exclusion, there were 65 patients with recurrence after operation. The clinical and pathological data of the patients were analyzed retrospectively. Including the basic information of the patient and the related factors that may influence the location and time of recurrence and metastasis, such as sex, age, primary tumor location, preoperative CEA, operation, digestive tract reconstruction, primary tumor size, histological type, and so on. The degree of differentiation, the depth of invasion, the status of lymph node metastasis, the stage of oncology, the location of recurrence and metastasis, the time of recurrence, and the relationship between them and various related factors were analyzed. The measurement data were expressed as mean 卤standard deviation (? X 卤S). The correlation factors of recurrence and metastasis after radical gastrectomy were analyzed by X list chi-square test (Chi-Square Tests, test). Results: among 372 patients, 65 patients had recurrence, the total recurrence rate was 17.5. among them, 42 cases had distant metastasis, the distant metastasis rate was 11.33.It accounted for 64.6% of the recurrent patients. In 23 cases of local recurrence, the local recurrence rate was 6.2%, accounting for 35.4% of the recurrent patients. The majority of the patients had recurrence and metastasis within 2 years, 49 times, and 16 cases of long term recurrence more than two years. The median recurrence time was 13 months (range 3-73 months), the median time of distant metastasis was 11.5 months (range 3-73 months) and the median time of local recurrence was 14 months (range 3-46 months). The statistical analysis indicated that N stage (P0. 006), tumor stage (P0. 006) had a significant correlation with the location of recurrence and metastasis after operation, and that the stage of oncology (P0. 011) had a significant correlation with the recurrence time after operation. The difference was statistically significant. The later the tumor stage, the greater the probability of distant metastasis and early recurrence. However, there was no significant correlation between the postoperative recurrence and metastasis and the recurrence time. Conclusion: 1. Distant metastasis was the main site of recurrence and metastasis after radical gastrectomy. 2. 2. Early recurrence was more common in patients with gastric cancer after radical operation, and recurrence time was significantly correlated with tumor stage, and early follow-up should be followed up more closely after operation. 3. In the surgical treatment of gastric cancer, more attention should be paid to the problem of distant metastasis and recurrence after operation. In some cases, the method of emphasizing the distance of proximal incisal margin mechanically should be further explored.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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