對漿膜侵犯之進行胃癌胃切除手術之檢討

Gastrectomy for Advanced Gastric Carcinoma with Serosal Involvement

吳誠中(Cheng-Chung Wu) ； 方俊慧(Tsin-Huei Fang) ； 劉自嘉(Tse-Jia Liu)

《The Kaohsiung Journal of Medical Sciences》 7卷1期 (1991/01) Pp. 7-14

https://doi.org/10.6452/KJMS.199101.0007

摘要

檢討過去6年間，本院以胃切除治療之胃癌病患，可接受追蹤結果者共485位，其中332例（68.2%）其癌病已侵犯至漿膜層（se）或周圍其他器官（sei），其年齡平均為64.8歲（範圍24-87歲）。有144例接受單純胃切除術（SG），188例則接受根治性胃切除術（RG）。對明顯有非治療因子（如多發肝轉移、腹膜接種及遠端轉移等）存在時，我們儘量作原發癌病的單純切除（SG）；其餘則視手術醫師任意選擇手術方式。
手術死亡率，SG為2.7%；RG為3.2 %，其中經SG手術者，平均每例可取得15.8個淋巴結，接受RG之病急可取得33.6個淋巴結，sei比se發生淋巴結轉移之機會較多。
按照日本胃癌處理規約，手術之結果，我們發現對漿膜侵潤不論是第3期或第4期胃癌病急，RG術後生存率遠比SG佳，對此等第3期病患若能得絕對治癒切除者，結果比相對治癒切除或非治癒切除者為佳，反之，對第4期病患則絕對治癒切除者無一例活過3年半，我們認為在病人情況許可，無遠端轉移時宜儘可能作到RG，且儘可能避免絕對非治療切除。

並列摘要

Four hundred and eighty five gastric cancer patients underwent gastrectomy in the past 6 years and of those 332 patients (68.2 %) were found to have only serosal involvement (se) or adjacent organ invasion (sei). Simple gastrectomy (SG) was carried out in 144 cases while radical gastrectomy (RG), which included systemic lymphadenectomy, was performed in 188 cases. This type of operation was chosen by the operators arbitrarily except in the presence of non-curative factors such as multiple liver metastasis, peritoneal seeding and distant metastasis, in which case SG was always used to relieve gastrointestinal obstruction or bleeding.
The operative mortality of SG was 2.7% and that of RG was 3.2%. On average, 15.8 lymph nodes were taken out per patient in SG and 33.6 lymph nodes in RG. The chance of nodal metastasis was higher in sei than in se.
According to the Japanese General Rules of Gastric Cancer Study, we found that for gastric cancer with serosal involvement: (1) the long term result of RG was superior to SG in both stage 3 and 4 patients, (2) when absolute curative resection was achieved, the result was the best in stage 3 patients, (3) no patient in stage 4 who underwent absolute non-curative resection survived for more than 42 months, therefore this result was the worst. RG is recommended for advanced gastric cancer patients with serosal involvement whenever the patient’s condition permits and in absence of the unresectable non-curative factors.

並列關鍵字

gastric carcinoma ； serosal involvement ； gastrectomy