残胃癌的外科治疗及预后分析

目的探讨残胃癌的外科治疗及影响预后的因素。方法对22例经外科手术治疗的残胃癌患者的临床资料及预后进行回顾性分析。结果本组残胃癌患者占同期收治的胃癌患者总数的3．3％。其中Ⅰ期4例，Ⅱ期2例，Ⅲ期6例，Ⅳ期10例。根治性切除率分别为77．3％，联合脏器切除率为50．0％：经腹腔完成残胃癌根治手术17例，经胸腹联合切口完成残胃癌根治手术4例，剖腹探查1例。全胃切除、ROHX-en-Y消化道重建21例。淋巴结转移率为63．6％．分别为pNo8例；pN．6例；pN27例；pN，1例。残胃癌Ⅰ、Ⅱ期患者生存时间（80．2±17．2）个月；Ⅲ期患者生存时间（31．2±9．2）个月；Ⅳ期患者生存时间（23．6±6．1）个月；Ⅰ、Ⅱ期患者的生存时间明显长于Ⅲ、Ⅳ期患者（P〈0．05）。术后生存率单纯残胃切除与联合脏器切除组比较差异无统计学意义（P〉0．05）；但姑息手术与标准根治手术及扩大根治手术组比较、不同分化腺癌组比较、淋巴结转移阳性与阴性组比较，差异均有统计学意义（均P〈0．05）。结论残胃癌外科治疗应选择在全胃切除D2淋巴结清扫基础上进行扩大根治手术和联合脏器切除：病期早晚、淋巴结转移与否、肿瘤生物学特性影响残胃癌患者预后。

Analyses of surgical treatment and prognosis in gastric stump cancer

Objective To evaluate the efficacy of surgical treatment and the prognosis in gastric stump cancer patients.Methods Between June 1994 and March 2004, 692 patients underwent radical operation for gastric cancer in our department. Among them, 22 cases were gastric stump cancer.Their surgical treatments, lymph node metastasis and survival were analyzed retrospectively. Results Gastric stump cancer accounted for 3.2 % of all the gastric cancer cases in the same period. There were 4 cases of stage Ⅰ , 2 cases of stage Ⅱ , 6 cases of stage Ⅲ and 10 cases of stage Ⅳ respectively. Radical excision was 77.3% and combined evisceration was 50.0%. Total gastrectomy were performed in 21 cases and exploratory laparotomy in 1 case. Digestive tract was reconstructed with Roux-en-Y pattern after total gastrectomy. Radical gastric stump cancer excisions were finished with abdominal incision in 18 cases and with thoraco-abdominal incision in 4 cases. Lymph node metastasis rate was 63.6 %, including pN0 8 cases, pN1 6 cases, pN2 7 cases and pN3 1 case respectively. Average survival time was (80.2±17.2) months in stage Ⅰ and Ⅱ gastric remnant cancer; average survival time was (31.2±9.2) months in stage Ⅲ gastric remnant cancer, average survival time was (23.6±6.1) months in stage Ⅳ gastric remnant cancer, which were significantly different(all P<0.05). Between palliative operation group and standard radical excision, extended radical excision groups, well-moderate differentiated and poor differentiated adenocarcinoma groups, lymph node metastasis positive and negative groups, the differences were all significant. Conclusions Total gastrectomy and D2 lymph node dissection are imperative for radical excision of gastric remnant cancer. On this base, extended lymphectomy and combined evisceration should be performed appropriately. Tumor stage, procedure pattern, lymph node metastasis and tumor differentiation affect the prognosis of patients with gastric stump cancer.