胃癌全胃切除术中预防性脾切除术的批判性评价

Critical evaluation of prophylactic splenectomy in total gastrectomy for the stomach cancer.

作者信息

Sugimachi K, Kodama Y, Kumashiro R, Kanematsu T, Noda S, Inokuchi K

出版信息

Gan. 1980 Oct;71(5):704-9.

Abstract

In gastric cancer surgery, an extended radical operation is commonly performed, and in cases of total gastrectomy, there is a tendency to perform splenectomy at the same time. However, some surgeons have reservations regarding this treatment in connection with the possible preservation of the host resistance. The question arises, is it reasonable to accept, by simple analogy with prophylactic lymphadenectomy the concept of the prophylactic splenectomy? The present study was designed to cast light on this problem. In order to examine the value of prophylactic splenectomy in gastric cancer surgery, a comparable patient group was followed up, and it was found that the non-splenectomized group showed a significantly better late survival rate than the splenectomized group (P less than 0.005), the 4-year survival rate being 63% in the former group and 36% in the latter group. Although these results do not necessarily contraindicate combined splenectomy, it seems desirable to reappraise the value of prophylactic splenectomy in cases having no metastasis in the splenic hilar and adjacent lymph nodes.

摘要

在胃癌手术中，通常会进行扩大根治术，在全胃切除的情况下，往往会同时进行脾切除术。然而，一些外科医生对这种治疗方法有所保留，因为这可能会影响机体抵抗力。问题来了，简单类比预防性淋巴结清扫术，预防性脾切除术的概念是否合理呢？本研究旨在阐明这一问题。为了探讨预防性脾切除术在胃癌手术中的价值，对一组可比患者进行了随访，结果发现未行脾切除术的组比行脾切除术的组具有显著更好的晚期生存率（P小于0.005），前一组的4年生存率为63%，后一组为36%。虽然这些结果不一定表明联合脾切除术是禁忌的，但对于脾门及邻近淋巴结无转移的病例，似乎有必要重新评估预防性脾切除术的价值。