【摘要】：目的:通過分析遠(yuǎn)端胃切除胃癌根治術(shù)術(shù)后復(fù)發(fā)患者的情況,探討胃癌手術(shù)治療新的思考切入點(diǎn)。方法:收集2010年08月至2015年10月廣西醫(yī)科大學(xué)附屬腫瘤醫(yī)院收治的372例行遠(yuǎn)端胃切除胃癌根治術(shù)病人的病案,按納入和排除標(biāo)準(zhǔn),共有65例術(shù)后復(fù)發(fā)病人,回顧性分析患者的臨床和病理等相關(guān)資料。包括患者的基本信息和可能影響復(fù)發(fā)轉(zhuǎn)移發(fā)生部位和復(fù)發(fā)時間的相關(guān)因素,如性別、年齡、原發(fā)腫瘤部位、術(shù)前CEA、手術(shù)方式、消化道重建方式、原發(fā)腫瘤大小、組織學(xué)類型、分化程度、浸潤深度、淋巴結(jié)轉(zhuǎn)移情況、腫瘤病期等,分析病人復(fù)發(fā)轉(zhuǎn)移發(fā)生的部位、復(fù)發(fā)時間等基本情況及其與各種相關(guān)因素之間的關(guān)系。計量資料采用均數(shù)±標(biāo)準(zhǔn)差(?X±S)表示。與遠(yuǎn)端胃切除胃癌根治術(shù)術(shù)后復(fù)發(fā)轉(zhuǎn)移發(fā)生部位、復(fù)發(fā)時間相關(guān)因素的分析比較采用行×列表的卡方檢驗(Chi-Square Tests,檢驗)。P0.05表示差異具有統(tǒng)計學(xué)意義。結(jié)果:在372例病人中術(shù)后復(fù)發(fā)65例,總復(fù)發(fā)率17.5%,其中發(fā)生遠(yuǎn)處轉(zhuǎn)移患者42例次,遠(yuǎn)處轉(zhuǎn)移率為11.3%,占復(fù)發(fā)病人的64.6%;局部復(fù)發(fā)患者23例次,局部復(fù)發(fā)率為6.2%,占復(fù)發(fā)病人的35.4%。大部分患者在2年內(nèi)出現(xiàn)復(fù)發(fā)轉(zhuǎn)移,共49例次,大于兩年的遠(yuǎn)期復(fù)發(fā)患者為16例次。本組病人中位復(fù)發(fā)時間為13個月(范圍3-73個月),發(fā)生遠(yuǎn)處轉(zhuǎn)移的中位時間為11.5個月(范圍3-73個月),局部復(fù)發(fā)的中位時間為14個月(范圍3-46個月)。統(tǒng)計分析結(jié)果提示N分期(P=0.006)、腫瘤病期(P=0.006)與術(shù)后復(fù)發(fā)轉(zhuǎn)移發(fā)生部位具有顯著相關(guān)性,腫瘤病期(P=0.011)與術(shù)后復(fù)發(fā)時間具有顯著相關(guān)性,差異具有統(tǒng)計學(xué)意義,腫瘤病期越晚,發(fā)生遠(yuǎn)處轉(zhuǎn)移及早期復(fù)發(fā)的可能性越大。而患者的手術(shù)方式、消化道重建方式、切緣距離等與術(shù)后復(fù)發(fā)轉(zhuǎn)移發(fā)生部位、復(fù)發(fā)時間無顯著相關(guān)性。結(jié)論:1.遠(yuǎn)端胃切除胃癌根治術(shù)術(shù)后患者復(fù)發(fā)轉(zhuǎn)移發(fā)生部位主要以遠(yuǎn)處轉(zhuǎn)移為主。2.胃癌根治術(shù)后患者以早期復(fù)發(fā)更常見,復(fù)發(fā)時間與腫瘤病期具有顯著相關(guān)性,術(shù)后早期更應(yīng)密切跟蹤隨訪。3.胃癌手術(shù)治療中更應(yīng)重視術(shù)后遠(yuǎn)處轉(zhuǎn)移復(fù)發(fā)的問題,在某些情況下,過分機(jī)械的強(qiáng)調(diào)近端切緣距離的做法有待進(jìn)一步探討。
[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 鹵standard deviation (? X 鹵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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.2

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