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題名 | Benefits of Palliative Surgery for Far-Advanced Gastric Cancer=晚期胃癌的緩解性手術之效益 |
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作者 | 王嘉修; 趙子傑; 詹益銀; 鄭隆賓; 黃燦龍; 陳敏夫; | 書刊名 | 長庚醫學 |
卷期 | 25:12 2002.12[民91.12] |
頁次 | 頁792-802 |
分類號 | 416.243 |
關鍵詞 | 胃癌; 緩解手術; 全胃切除術; Gastric cancer; Palliative surgery; Total gastrectomy; |
語文 | 英文(English) |
中文摘要 | 背景:針對晚期胃癌病人的緩解性外科治療,最完善的策略迄今尚未有定論。 方法:於1994各2004年間總共有525位晚期胃癌病人接受緩解性外科治療。本文旨在分析此類手術的危險性、存活、和緩解效果等各方面的優劣點,評估其效益。依據UICC有關術後殘餘腫瘤(R)的分類法:顯微的殘餘腫瘤(R1)有104人,和肉眼的殘餘腫瘤(R2)有421人。所有R1病人和257位R2病人施行胃切除術。非切除手術共施行於164位R2病人,包括:胃空腸吻合術(N=64),胃造?術(N=17),空腸造?術(N=60),和單開腹(N=23)。 結果:R1造端胃切除術,R2遠端胃切除術,和R1全胃切除術的手術死亡率分別是4.5%,3.3%,各2.9%,其間並無明顥差別。R2全胃切除手術之手術死亡率(10.9%)特別的高出以上各種切除手術。除了R2全胃切除手術外,各種緩解性切除後的存活時間和有效緩解期都比非切除手術長久。緩解手術以後化學治療有延命的效果。 結論:對於晚期胃癌病人,R1或R2遠端胃切除術或R1全胃切除術具有延命或緩解症候的效果。但是施行R2全胃切除術必須做有選擇性的決定,或考慮以其他比較不侵襲的治療方法來取代以減低手術死亡率。緩解手術以後化學治療也有延命的好處。 |
英文摘要 | Background: The optimum strategy for palliative surgery in gastric cancer patients remains undetermined. Methods: In total, 525 patients who had undergone palliative surgery between 1994 and 2000 were evaluated in terms of operative mortality, survival, and palliative effect. Patients were grouped according to the UICC’s classification of residual tumors (R) after the operation: microscopic residual tumor (R1) (N=104) and macroscopic residual tumor (R2)(N=421). Gastric resection was performed in all R1 patients and in 257 of the R2 patients. Non-resection procedures were performed in 164 of the R2 patients, including gastrojejunostomies in 64, gastrostomies in 17, jejunostomies in 60, and laparotomies only in 23. Results: The operative mortality did not significantly differ among R1 distal gastrectomies (4.5%), R2 distal gastrectomies (3.3%), and R1 total gastrectomies, (2.9%) (p=0.919). R2 total gastrectomies showed a particularly higher operative mortality (10.9%) than did the other resection procedures. The survival time and palliative duration were significantly longer in patients after palliative resection than after non-resection operations. Postoperative chemotherapy prolonged the survival time of patients after palliative surgery. Conclusion: R1 or R2 distal gastrectomies and R1 total gestrectomies have benefits of survival prolongation and symptomatic palliation. However, the use of a total gasterctomy in R2 patients must be selectively reserved for far-advanced cases, otherwise it should be replaced with less-invasive procedures to avoid a high operative mortality rate. Postoperative chemotherapy is useful for prolonging survival time. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。