残胃癌的临床特征及外科治疗

目的:探讨残胃癌的临床特点及合理的外科治疗。方法:回顾性分析近5年我院收治58例残胃癌患者的临床资料。结果:残胃癌多发生于胃大部切除术10年后,BillrothⅡ式发生率显著高于BillrothⅠ式,临床表现缺乏特异性,好发于吻合口或其附近的黏膜,其次小弯侧、胃底贲门部,残胃癌的组织学分化差,多数已属中、晚期,手术是残胃癌的主要治疗手段,手术切除率和根治切除率分别为60.3%和55.2%,根治术后生存期明显延长。结论:为减少残胃病变,尤其是残胃癌的发生,必须严格掌握胃大部分切除术适应证和选择合理的手术方式,而且手术后定期内镜检查,早期发现残胃癌,予以行残胃癌根治术治疗。     

残胃癌的临床病理特征及外科治疗

目的：探讨残胃癌的临床病理特征，以提高早期诊断率及根治性切除率。方法：回顾性分析1985年1月～2003年6月收治的27例残胃癌。结果：原胃大部切除术至残胃癌确诊间隔时间平均为20．1年，原手术方式中21例为Billroth Ⅱ式吻合。出现症状距确诊平均间隔6个月(1～14个月)。残胃发生部位11例在吻合口。印戒细胞癌3例，未分化癌5例，低分化腺癌8例，中、高分化腺癌11例。IA期1例，Ⅱ期4例，ⅢA期7例，ⅢB期4例，Ⅳ期11例。23例行手术治疗，其中13例行残胃癌根治术，6例仅行剖腹探查术，4例行姑息性手术。结论：残胃癌多发生于Billroth Ⅱ式胃大部切除术后，病变主要位于吻合口附近。残胃癌易延误诊断，当胃大部切除术后5年以上，出现上腹隐痛不适、饱胀感、上消化道出血、恶心呕吐、进食梗噎感等，应考虑到残胃癌的可能，争取早期诊断。根治性手术是治疗残胃癌的有效方法。     

残胃癌6例诊治体会

作者自 1 980～ 1 998年间共收治残胃癌 6例 ,现报告如下。1　临床资料本组 6例 ,男性 5例 ,女性 1例 ,年龄 41～ 76岁 ,平均 58.4岁。初次手术时诊断为良性胃十二指肠溃疡者 4例 ,胃多发性息肉 1例 ,胃癌 1例 ,手术行ＢｉｌｌｒｏｔｈⅠ式吻合 1例 ,ＢｉｌｌｒｏｔｈⅡ式吻合 5例。残胃癌发病距初次手术时间为 7～ 31年 ,其中 1例胃癌为 1 6年 ,6例均行 2次手术 ,其中 2例行根治性残胃全切除术 ,3例行姑息性残胃全切除术 ,1例行残胃—空肠输出袢侧侧吻合加原输入袢与新输出袢侧侧吻合术。术后随访 1例生存 6月 ,3例生存 1年以上 ,2例生存 3…     

胃部分切除术后早期大出血再手术12例临床分析

目的:探讨胃部分切除术后早期大出血的原因和再手术方法.方法:回顾性分析我院2000年9月至2010年9月收治的12例胃部分切除术后早期大出血再手术病人的临床资料.结果:吻合口出血6例,旷置十二指肠溃疡和残胃应激性溃疡出血各2例,遗漏病灶、残胃黏膜损伤出血各1例.结论:吻合口出血是胃部分切除术后早期出血的多见原因,胃肠开放性吻合能有效预防胃部分切除术后出血,必须正确掌握再手术指征和手术方法.     

残胃癌的诊治分析

残胃癌是指为治疗胃、十二指肠溃疡病或其它良性病变行胃部分切除术后剩余胃内发生的癌.为了排除初次手术时胃内已有的隐匿的早期癌病变,一般将残胃癌限于手术后5年以上才发现的癌[1].其有恶性度高,预后差以及手术切除率低等特征,给临床治疗带来许多困难.本研究的目的是分析残胃癌患者临床、病理特征,探讨提高残胃癌的早期诊断和最佳外科治疗方式.     

105例老年胃大部切除术后残胃病变的回顾分析

目的 回顾分析老年残胃病变的临床特点及胃镜表现.方法 对105例老年胃大部切除术后残胃病变患者的临床资料进行回顾性分析.105例患者中,34例(32.38％)采用毕Ⅰ(BI)式手术,71例(67.62％)采用毕Ⅱ(BⅡ)式手术,所有患者均行胃镜及组织病理检查.结果 所有患者中残胃癌15例(14.29％),吻合口及残胃溃疡14例(11.43％),胆汁反流42例(40.O％),吻合口及残胃炎34例(32.38％).并发息肉13例(12.38％),幽门螺杆菌阳性33例(31.43％).统计分析显示,BⅡ式术后残胃癌、吻合口及残胃炎、胆汁反流的发生率高于(BⅠ)式(P＜0.05),而BⅡ幽门螺杆菌阳性率较BⅠ低(P＜0.05).结论BⅡ式较BⅠ式术后更易发生并发症,老年残胃癌变、炎症和胆汁反流发生率均较高,应定期随防胃镜及病理检查.     

残胃癌26例诊治分析

目的探讨残胃癌的早期诊断和治疗方法。方法26例患者术前均行胃镜组织活检及上消化道钡餐检查;26例均行手术治疗。根治性切除13例,包括残胃全切除＋胰体尾＋脾2例,残胃全切除5例,残胃远端胃大部切除6例;姑息性切除7例;因吻合口处肿块巨大不能切除仅行输出袢短路吻合术加空肠造瘘术4例;因腹腔内广泛转移仅行肿块活检术2例。结果胃镜组织活检对残胃癌的诊断率明显高于上消化道钡餐;行根治性残胃切除的手术效果明显高于其他手术方式。结论胃镜组织活检是残胃癌早期诊断的重要手段.根治性残胃切除是早期残胃癌首选的治疗方法。胃镜对残胃癌的诊断价值优于钡餐。早期诊断并行根治性残胃切除患者预后较好。     

17例残胃癌临床诊治分析

目的 探讨残胃癌的临床诊治特点、预后。方法 回顾性分析我院1990年1月～2006年6月收治的17例残胃癌病人临床资料。结果 本组术后1例发生食管空肠吻合口瘘，肺部感染1例。姑息性切除患者，其生存时间为4～12个月，平均8．9个月。根治性切除患者1、3、5年生存率分别为80.2％、44．7％、30．8％。结论残胃癌多发生于BillrothⅡ式胃大部切除术后。根治性切除是治疗残胃癌的有效方法。定期胃镜复查，早期诊断，早期治疗是提高残胃癌预后的关键。     

残胃癌12例临床分析

目的探讨残胃癌的临床特点、外科诊断和治疗。方法对12例残胃癌患者进行回顾纠正分析。结果首次胃切除以胃溃疡为主，占83．3％，首次手术以B-Ⅱ式为主，占83．3％。本组手术切除率为75％，根治切除术为50％，残胃癌发生在吻合口占8．3％，残胃小弯侧占33．3％，残胃大弯侧占50％。结论对50岁以上的男性胃部分切除者，建议定期约胃镜检查，外科治疗以根治性全胃切除加D2淋巴结清扫术为宜，早期诊断、早期治疗是提高残胃癌预后的关键。     

残胃贲门癌残胃食管癌的外科疗效

目的 报告残胃贲门癌残胃食管癌的手术治疗效果。方法 1982年5月～2003年11月手术治疗28例残胃责门癌或残胃食管癌病人。结果 残胃贲门癌或残胃食管癌男性多于女性，初次胃部分切除手术距残胃癌的诊断时间平均为12，8年，71．4％为BillrothⅡ式吻合者。28例均行根治性手术治疗。结论 胃部分切除5年以上出现上消化道症状的病人，应考虑残胃贲门癌、残胃食管癌的可能，争取早期诊断、早期施行手术。残胃贲门癌可行全胃切除，P形空肠袢代胃Roux-en-Y式吻合重建消化道具有储存食物、防止返流性食管炎的功能，同时可以切除足够长度食管，防止癌肿残留。残胃食管癌切除后可采用结肠代食管。残胃贲门癌和残胃食管癌的手术治疗可获得与原发性贲门癌和食管癌同样的效果。     

1195例胃大部切除术后残胃病变临床与内镜检查分析

目的通过分析胃大部切除术后残胃病变的临床特点及内镜表现,探讨不同手术方式对病变的影响。方法将本院1984年4月至2008年10月检出的1195例残胃患者按毕Ⅰ式和毕Ⅱ式进行分组,对其临床症状、内镜表现、病理结果及随访情况进行回顾性分析。结果胃大部切除术后残胃病变发生率高达98．08％,毕Ⅱ式术后残胃及吻合口炎（90．77％）、胆汁反流（71．59％）、残胃原发癌（4．55％）的发生率均显著高于毕Ⅰ式（51．15％、34．48％、1．72％）,P〈0．01,残胃及吻合口溃疡发生率则是毕Ⅰ式（28．45％）明显高于毕Ⅱ式（16．73％）,P〈0．01,其余残胃病变两组比较差异无统计学意义（P〉0．05）。结论胃大部切除术是治疗胃恶性肿瘤、消化性溃疡及其严重并发症的主要方法,毕Ⅱ式较毕Ⅰ式术后更易发生并发症;近年来,残胃病变发病率有下降趋势;定期复查内镜及病理是防治残胃病变尤其是残胃癌的重要措施。     

Gastric stump carcinoma following Billroth II resection for peptic ulcer disease. Comparison with cancer in non-operated stomach

40 gastric stump carcinomas have been investigated. The results are compared with 72 gastric carcinomas without preceding Billroth II resection. The aim of this study was to contribute to our knowledge about the pathogenesis of gastric stump carcinoma. The mean age of patients with gastric stump carcinoma and with carcinoma without preceding Billroth II resection is identical. The age distribution, too, is similar in both groups. Furthermore the time of the Billroth II resection for benign peptic ulcer shows no correlation with the appearance of the gastric stump carcinoma, which suggests that there is no constant time lag between Billroth II resection and stump carcinoma. The histological investigation of the tumor-free gastric mucosa shows similar alterations in the two groups compared. Intestinal metaplasia and cystic dilatation seems to be more common in the gastric mucosa after Billroth II resection as compared with the non-tumorous mucosa of patients without preceding Billroth II resection. But the grade of nuclear atypia in non-tumorous mucosa is identical in both groups. Interestingly enough, the frequency of the main types of gastric cancer, intestinal carcinoma and diffusely infiltrating carcinoma is very similar. Thus, both the epidemiological and histological data seem to indicate that the pathogenesis of gastric carcinoma is very similar to that of gastric carcinoma without preceding gastric surgery. The Billroth II resection does not seem to be a main factor in pathogenesis, but may have co-factorial significance.     

Mixed neuroendocrine carcinoma of the gastric stump: A case report

BACKGROUNDGastric stump cancer, also known as gastric remnant cancer (GRC), is one of the main complications of postgastrectomy syndrome, which usually occurs following Billroth II reconstruction. The predominant histological subtype of GRC is adenocarcinoma, whereas neuroendocrine carcinoma is relatively rare. In particular, there are few recently reported cases of mixed neuroendocrine carcinoma (MNEC) in the English literature. Here, we present an extremely rare case of MNEC of the gastric stump.CASE SUMMARYA 59-year-old patient presented to our department owing to chronic constipation. He had undergone subtotal gastric resection 35 years prior to admission because of benign peptic ulcer. After admission, the patient underwent several tests, and gastroendoscopy showed evidence of Billroth II gastrectomy and local thickening of the gastric stump mucosa at the gastrojejunostomy site, with bile reflux; pathological biopsy revealed adenocarcinoma. He was then diagnosed with GRC and underwent total gastrectomy, D2 Lymphadenectomy, and esophagojejunal Roux-en-Y reconstruction. Histopathological examination of the specimen identified MNEC comprising MNEC (60%), adenocarcinoma (30%), and squamous cell carcinoma (10%). Postoperative adjuvant chemotherapy was initiated on September 17, 2020. Taxol plus cisplatin was administered for only one cycle because of severe liver function damage, and the regimen was changed to etoposide plus cisplatin on October 10, 2020 for five cycles. The patient recovered, with no recurrence after 6 mo of follow-up.CONCLUSIONGastric MNECs (GMNECs) is a rare type of GRC. This study presented the unusual occurrence of GMNEC in the gastric stump. This case will contribute to improvements in our understanding of the carcinogenesis, biology, pathology, and behavior of GMNEC and GRC.     

Gastric stump cancer: etiopathological and clinical aspects

Between 1959 and 1987, at the Innsbruck University Hospital, 359 cases of carcinoma were diagnosed in the gastric remnant. While until 1975 in 203 patients suffering from stump carcinoma the tumor stages T3 and T4 were significantly prevalent, a strong tendency towards the less advanced tumor stages T1 and T2 was observed in the last decade. Among 94 patients operated on since 1981 the tumor was located at the anastomosis in all but 5 cases, suggesting a strong connection between previous resection and stump carcinoma. In accordance with Lauren's classification no difference was found in the incidence of intestinal and diffuse lesions in 94 cases with stump carcinoma--in contrast to 69 cases of patients with a non-resected stomach. An analysis of the occurrence of acidity, atrophic gastritis and bacterial invasion in 70 patients with previous Billroth II resection and 30 patients with Billroth I resection, revealed no difference between the two types of resection. Gastric remnant carcinoma does not occur exclusively in the Bilroth II remnant, but, increasingly, following Billroth I operations. The finding of a statistically highly significant increase at the 5% level using standard chi 2-technique for a 2 x 5 table in stump carcinomas following Billroth I resections supports the thesis that there is no difference in the etiopathology of carcinogenesis in the Billroth I as compared with the Billroth II remnant.     

改良毕II式与传统毕II式术后并发症对比分析

目的 探讨与传统毕II式相比,改进毕II式对降低术后并发症发生率的优势.方法 回顾性分析比较190例接受改进毕II式和181例接受传统毕II式手术的胃十二指肠溃疡及胃癌病例资料.结果 与传统毕II式相比,改进毕II式显著降低了胃排空障碍、吻合口破裂或瘘、十二指肠残端瘘、输入襻综合征、输出襻梗阻、碱性反流性胃炎、溃疡复发、腹泻等并发症的发生率(P<0.05).结论 与传统毕II式相比,改进毕II式对降低术后并发症效果明显,是治疗胃十二指肠溃疡及胃癌的可靠术式之一.     

老年人胃十二指肠溃疡穿孔的临床特点及外科治疗

目的探讨老年人胃十二指肠溃疡穿孔的临床特点与外科治疗。方法对56例老年人消化性溃疡穿孔患者的临床资料进行回顾性分析。结果56例中胃溃疡穿孔38例,十二指肠球部溃疡穿孔18例;56例均行手术治疗,其中毕Ⅱ式胃大部分切除术34例,毕I式3例,单纯修补16例,胃癌根治术（D2式）3例。56例中治愈或好转54例,死亡2例。结论老年人消化性溃疡穿孔具有临床表现不典型、溃疡病史长与穿孔较大、并存疾病多的特点;外科治疗应视患者具体情况和病情选择适宜的术式,重视围术期的处理,是提高老年人胃十二指肠溃疡穿孔治愈率的关键。     

Sonographic diagnosis of obstructed afferent loop

We reviewed the sonographic findings in four patients with afferent loop obstruction from tumor of the gastric stump. All had undergone partial gastrectomy with Billroth type II gastrojejunostomy. The obstructed afferent loop was visible in all cases as a distended fluid-filled segment with multi-layered wall and few mucosal folds. Its course could be traced from the region of the hepatic hilum to the gastric stump. In two patients, the relationships between the loop and the mesenteric vessels, aorta and inferior vena cava allowed us to recognize it as postoperative duodenum. Thickening of the gastric remnant and obstructive jaundice were diagnosed in three cases. Since sonography is often used as the first imaging method in patients with abdominal complaints, knowledge about postsurgical appearance of the gastrointestinal tract is very important in detecting such pathological conditions.     

Laparoscopic stomach‐partitioning gastrojejunostomy in preparation for distal gastrectomy and Billroth‐II reconstruction after neoadjuvant chemotherapy for advanced gastric cancer with gastric outlet obstruction: A case report

Gastrojejunostomy has been performed as a palliative treatment for unresectable, advanced gastric cancer patients with gastric outlet obstruction (GOO). However, its role before neoadjuvant chemotherapy (NAC) has not been established. We present the case of a 72‐year‐old man with distal advanced gastric cancer with GOO. Computed tomography showed para‐aortic lymph node (PAN) metastasis without other distal metastasis. We performed laparoscopic stomach‐partitioning gastrojejunostomy (LSPGJ), which avoided new gastrojejunostomy reconstruction when performing distal gastrectomy after NAC. His oral intake improved after surgery and NAC was successfully administered on postoperative day 14, without surgical complications. After completion of NAC, the patient underwent radical distal gastrectomy with gastrojejunostomy reused as Billroth‐II reconstruction. A histological examination revealed no residual cancer cells. LSPGJ, with partitioning on the expected resection line in distal gastrectomy after NAC, can be useful for treating advanced gastric cancer with GOO when NAC followed by curative gastrectomy is planned.     

Lymphoma of the stomach following gastric surgery for benign peptic ulcers

Adenocarcinoma of the gastric stump is a well-known complication of gastroduodenal surgery for benign lesions. However, we report 2 unusual cases wherein malignant lymphoma originated in the postoperative stomach. The first patient had undergone partial gastrectomy and Billroth II procedure 20 years earlier. The gastric lymphoma of the second patient manifested 39 years after vagotomy and pyloroplasty. In both instances, the tumor caused marked thickening and nodularity of the rugal folds without affecting the distensibility of the previously operated stomach. Differential diagnostic features of the observed findings and the potential carcinogenic effects of gastroduodenal surgery are reviewed.     

Current controversies in treating remnant gastric cancer: Are minimally invasive approaches feasible?

The incidence of remnant gastric cancer (RGC) is still increasing. Minimally invasive approaches including endoscopic resection, laparoscopic and robotic approaches, and function-preserving gastrectomy have been utilized as curative treatment methods for primary gastric cancer. However, adhesions and anatomical alterations due to previous gastrectomy make the use of minimally invasive approaches complicated and difficult for RGC. Application of these approaches for the treatment of RGC is still controversial. Endoscopic submucosal dissection is a favorable alternative therapy for the resection of early gastric cancer that occurs in the remnant stomach and can prevent unnecessary complications. The majority of retrospective studies have shown that endoscopic submucosal dissection is an effective and oncologically safe treatment modality for RGC. Subtotal gastrectomy could serve as a function-preserving gastrectomy for patients with early RGC and improve postoperative late-phase function. However, there are only two studies that demonstrate the feasibility and oncological efficacy of subtotal gastrectomy for RGC. The non-randomized controlled trials showed that compared to open gastrectomy, laparoscopic gastrectomy for RGC led to better short-term outcomes and similar oncologic results. Because of the rarity of RGC, future multicenter studies are required to determine the indications of minimally invasive treatment for RGC.