残胃癌32例临床诊治分析

Surgical management of gastric stump cancer: a report of 32 cases

关键词:  残胃癌  胃恶性肿瘤  消化性溃疡  胃大部切除术

Key words:  gastric stump cancer  diagnosis  management

摘要:

［目的］研究广义残胃癌（gastric stump cancer，GSC）的预后情况和影响预后的相关因素。［方法］回顾性分析1999～2009年期间收治的32例GSC患者临床资料，所有病例全部经胃镜和CT确诊。发病距前次手术时间平均（375.75±131.47）月，其中消化性溃疡（411.56±109.47）月，胃癌（182.40±26.02）月。I期4例，II期8例，III期7例，IV期7例。行根治手术20例，姑息手术10例，未手术2例。手术方式中残胃全切加Roux-en-y吻合24例，残胃部分切除加Roux-en-y吻合2例，剖腹探查2例，造瘘术2例。［结果］32例患者中，无手术死亡病例。1、3、5年总生存率分别为71%，61%，36%。残胃癌TNM分期和手术是否根治是影响残胃癌预后的重要因素。Cox多因素分析显示，手术是否根治是唯一的预后影响因子。［结论］早期诊断和早期治疗，提高手术的根治率是改善GSC病人预后的关键。

Abstract:

［Objective］To evaluate the prognostic factors of gastric stump cancer (GSC).［Methods］Clinical data of 32 GSC patients who were admitted into the surgery department of the hospital from 1999 to 2009 were analyzed in this study.All cases were diagnosed with gastroduodenoal endoscopy and CT scan.The time from the first gastrectomy to the diagnosis of the GSC was(375.75±131.47) months in average,in which it was (411.56±109.47) months for peptic ulcer and (182.40±26.02) months for gastric cancer.Of 32 cases,4 cases were in stage I GSC,8 in stage II,7 in stage III,and 7 in stage IV,respectively.Radical surgery was performed in 20 cases and palliative surgery was done in 10 cases.The management was divided into total remnant gastrectomy combining Roux-en-y anastomosis in 24 cases,partial remnant gastrectomy combining Roux-en-y in 2 cases,open exploration in 2 cases,ostomy in 2 cases,and no surgery in 2 cases respectively.［Results］The time was shorter in the GCS after the gastrectomy of gastric cancer than that in peptic ulcer.No hospital death occurred in the 32 cases.The 1,3 and 5-year overall survival rates were 71%,61% and 36% respectively.The TNM stage of GSC and whether the radical surgery was performed were the prognostic factors.Cox regression multi factors analysis suggested the only factor that could improve the GSC prognosis,is the radical surgery.［Conclusion］Early diagnosis and management are important for GSC prognosis improving.