Chernousov A F, Chernousov F A, Selivanova I M, Fishkova Z P
Khirurgiia (Mosk). 2006(7):4-9.
Results of surgical treatment of 170 patients with early cancer of the stomach are analyzed. There were 113 patients with tumor invasion within the bounds of the mucous membrane (m -- 113), the others had invasion within the bounds of the submucous membrane (sm -- 57 patients). Impressed and ulcered macroscopic types of early cancer (IIc + III) were diagnosed most often: 57% m+sm (97 of 170), 58.4% m+sm (97 of 170), 54.4% sm (31 of 57), respectively. Poorly differentiated tumors prevailed over moderate- and well-differentiated tumors - 68.8% (117 of 170) and 31.2 (53 of 170) patients, respectively. Subtotal distal resection of the stomach has been performed in 118 (69,4%) patients, subtotal proximal resection -- in 13 (7.7%), gastrectomy -- in 22 (12.9%), resection of 2/3 stomach -- in 14 (8.2%), resection of the cardia - in 3 (1,8%). Lymphadenectomy has been performed in 156 patients including 1 (0.6%) patient with D0-lymphadenectomy, 88 (56.4%) - D1, 62 (39.7%) -- D2, and 5 (3.2%) -- D3. Metastases to the regional lymph nodes have been revealed in 8 (5%) cases -- 2 m and 6 sm. Extended lymphodissections (D2 and D3) have improved significantly long-term results. Five-year survival among the patients who had undergone extended operations with D2 and D3 lymphadenectomies was higher compared with patients after limited and standard operations (D0 and D1) -- 96.0+/-2.5 and 87.0+/-3.5%, respectively.
分析了170例早期胃癌患者的手术治疗结果。其中113例患者的肿瘤侵犯局限于黏膜层(m期——113例),其余患者的肿瘤侵犯局限于黏膜下层(sm期——57例)。早期胃癌最常诊断出的大体类型为凹陷型和溃疡型(IIc + III):m期+ sm期患者中分别占57%(170例中的97例)、58.4%(170例中的97例),sm期患者中占54.4%(57例中的31例)。低分化肿瘤多于中分化和高分化肿瘤——分别为68.8%(170例中的117例)和31.2%(170例中的53例)患者。118例(69.4%)患者进行了远端胃次全切除术,13例(7.7%)进行了近端胃次全切除术,22例(12.9%)进行了胃切除术,14例(8.2%)进行了胃2/3切除术,3例(1.8%)进行了贲门切除术。156例患者进行了淋巴结清扫术,其中1例(0.6%)患者进行了D0淋巴结清扫术,88例(56.4%)进行了D1清扫术,62例(39.7%)进行了D2清扫术,5例(3.2%)进行了D3清扫术。8例(5%)病例发现区域淋巴结转移——2例m期和6例sm期。扩大淋巴结清扫术(D2和D3)显著改善了长期结果。与接受有限和标准手术(D0和D1)的患者相比,接受D2和D3淋巴结清扫术的扩大手术患者的五年生存率更高——分别为96.0±2.5%和87.0±3.5%。