中文摘要：

目的比较远端胃切除术与全胃切除术对远端胃癌患者术后并发症和长期生存的影响。方法回顾性分析2008年5月至2015年4月间第四军医大学附属西京医院收治的1140例远端胃癌患者的临床资料，其中行根治性全胃切除术148例，远端胃切除术992例（毕I式207例，毕Ⅱ式785例）。以肿瘤大小、病理类型和浸润深度为匹配变量，对行全胃切除和远端胃切除术病例进行gmatch完全配对，成功配对71对，其中远端胃切除组142例。全胃切除组71例。比较两组患者术后并发症发生率和3年总体生存率。结果与全胃切除组相比，远端胃切除组平均手术时间缩短（198．8rain比236．0min，P=0.001），术中失血量减少（197．1ml比252．8ml，P=0.033），术后平均住院时间明显缩短（7．8d比8．5d，P=0．036），但术中淋巴结清扫数目减少（24．0枚／例比27．3枚／例，P=0.022）。两组患者术后各项并发症发生率间的差异均无统计学意义（均P〉0.05）。术后所有病例均获3年随访，中位随访时问20（2～66）月，远端胃切除组患者的3年总生存率显著高于全胃切除组（74．4％比58．7％，P=-0.013）。结论远端胃切除术应用于远侧胃癌，其手术安全性与全胃切除术相当，但可改善术后远期生存。推荐将根治性远端胃切除术作为远侧胃癌患者的首选术式。

英文摘要：

Objective To compare the long-term survival and the postoperative complication morbidity of distal gastric cancer patients between distal gastrectomy （DG） and total gastrectomy （TG）. Methods Clinicopathological data of 1140 patients with distal gastric cancer undergoing curative gastrectomy from May 2008 to April 2015 were analyzed retrospectively. A total of 992 patients underwent DG （207 patients of Billroth I and 785 of Billroth Ⅱ ） and 148 patients underwent TG. Patients between the I）G and TG group were selected using gmatch methods based on tumor size （＋1 cm）, differentiated degree and depth of invasion in order to reduce the differences in clinicopathological characteristics. Results Compared with TG group, the DG group had significantly shorter operation time （198.8 min vs. 236.0 min, P=0.001）, less blood loss （197.1 ml vs. 252.8 ml, P=0.033）, and shorter postoperative hospital stay （7.8 days vs. 8.5 days, P=0.036）. However, the postoperative complication morbidity and mortality were not significantly different between the two groups （P〉0.05）. Tile 3-year survival rate was significantly higher in the DG group compared to the TG group （74.4% vs. 58.7%, P=0.013）. Conclusions Compared with TG, DG has a comparable safety and a better long- term survival. DG should be considered as the optimal choice for patients with distal gastric cancer.