针对处于疾病终末期（TNM 分期为 IV 期）的胃癌患者进行的手术。

Surgery for patients with gastric cancer in the terminal stage of the illness - TNM stage IV.

作者信息

Budisin N I, Majdevac I Z, Budisin E S, Manic D, Patrnogic A, Radovanovic Z

机构信息

Institute of Oncology Vojvodina, Department of Surgery, Faculty of Medicine Novi Sad, Sremska Kamenica, Serbia.

出版信息

J BUON. 2009 Oct-Dec;14(4):593-603.

PMID:20148448

Abstract

PURPOSE

To assess any survival advantage in patients with incurable gastric cancer who had undergone resection, bypass or exploratory surgery. In nonresectable patients with pain, the effect of celiac plexus neurolysis was assessed.

METHODS

We retrospectively analysed data of 330 patients, operated between 1992 and 2006. The patients were followed until death or last examination. Incurable gastric cancer was defined as TNM stage IV disease: locally advanced (LA), with solitary distant metastasis (SM) or with multiple metastases and/or peritoneal carcinomatosis (MMC). The patients were divided into these 3 groups. Their postoperative survival was calculated and compared in relation to the surgical technique used. Factors which influenced mortality and survival were identified.

RESULTS

131 patients (39.7%) had locally LA cancer, 98 (29.7%) SM, and 101 (30.6%) belonged to the MMC group. The surgical procedures included 138 (41.8%) exploratory laparotomies, 84 (25.5%) bypass procedures and 108 (32.7%) resections. Thirty-three (10%) unresectable patients with pain underwent celiac plexus neurolysis. The mean survival was 21.8 months after resections, 7 months after by-passes and 4.8 after exploratory laparotomies (p = 0.0001). It was 14.57 months (p=0.001) in the LA group, 12.53 (p = 0.005) in the SM group, and 5.2 in the MMC group. Survival was shorter in patients with preoperative weight loss of more than 20 kg (3.2 months, p <0.0001). Postoperative 30-day mortality was 23.2% after exploratory laparotomies, 23.8% after bypasses and 20.4% after resections. Increased mortality was observed in the MMC group (27.7%) and in multivisceral resections (41%, p > 0.05), while significantly increased mortality occurred in patients with weight loss of over 20 kg (32%, p=0.03). Celiac plexus neurolysis was immediately effective in 30 out of 33 (91%) patients (p=0.0001), while 3 months later it was still effective in 15 (45.5%) patients (p=0.08).

CONCLUSION

Resections are suggested in the LA and SM groups, and neurolysis in all nonresected patients with pain.

摘要

目的

评估已接受切除、旁路或探查手术的无法治愈的胃癌患者的生存优势。对于无法切除且伴有疼痛的患者，评估腹腔神经丛松解术的效果。

方法

我们回顾性分析了1992年至2006年间接受手术的330例患者的数据。对患者进行随访直至死亡或最后一次检查。无法治愈的胃癌定义为TNM分期IV期疾病：局部晚期（LA）、伴有孤立远处转移（SM）或伴有多发转移和/或腹膜癌转移（MMC）。将患者分为这3组。计算并比较他们与所采用手术技术相关的术后生存率。确定影响死亡率和生存率的因素。

结果

131例患者（39.7%）患有局部LA癌，98例（29.7%）患有SM，101例（30.6%）属于MMC组。手术方式包括138例（41.8%）探查性剖腹术、84例（25.5%）旁路手术和108例（32.7%）切除术。33例（10%）无法切除且伴有疼痛的患者接受了腹腔神经丛松解术。切除术后平均生存期为21.8个月，旁路手术后为7个月，探查性剖腹术后为4.8个月（p = 0.0001）。LA组为14.57个月（p = 0.001），SM组为12.53个月（p = 0.005），MMC组为5.2个月。术前体重减轻超过20 kg的患者生存期较短（3.2个月，p <0.0001）。探查性剖腹术后30天死亡率为23.2%，旁路手术后为23.8%，切除术后为20.4%。MMC组（27.7%）和多脏器切除患者（41%，p > 0.05）的死亡率增加，而体重减轻超过20 kg的患者死亡率显著增加（32%，p = 0.03）。33例患者中有30例（91%）腹腔神经丛松解术立即有效（p = 0.0001），3个月后仍有15例（45.5%）有效（p = 0.08）。