残胃癌的外科治疗及临床因素分析

目的：分析残胃癌的临床特点、治疗策略和预后。方法：回顾性分析我院2009年1月至2012年10月收治的38例残胃癌患者的临床资料，分析其临床特点，比较不同治疗方案对患者预后的影响。结果：残胃癌多发生于胃大部切除毕Ⅱ式术后，占63.2%。残胃癌多发生在吻合口和吻合口附近，占60.5%。全组患者1、3和5年生存率分别为68.4%、39.5%和10.5%。手术组术后1、3和5年总生存率分别为80.6%、48.4%、12.9%，非手术组为14.3%、0、0，差异有统计学意义（P <0.05）。根治性手术组术后1、3和5年总生存率分别为95.2%、62.0%和19.0%，非根治性手术组为50.0%、20.0%和0，差异有统计学意义（P <0.05）。多因素预后分析显示，TNM 分期、分化程度和手术方式是影响残胃癌患者预后的独立因素。结论：残胃癌好发于毕Ⅱ式术后的吻合口和吻合口附近。外科治疗是治疗残胃癌的根本方法，根治性手术（包括联合多脏器切除）是获得长期疗效可靠的方法。

Surgical treatment and clinical analysis of gastric stump carcinoma

Objective:To analyze the clinical features,surgical treatment and prognosis of the gastric stump carci-noma. Methods:Retrospective analyze of 38 gastric stump carcinoma patients that were treated from January 2009 to October 2012 in our hospital. Results:The most gastric stump carcinoma were located in the anastomotic and the anastomsis near after BillrothⅡ style postoperative. The survival rates of 1,3 ,5 years were 68. 4% ,39. 5% and 10. 5% ;Survival rates of 1,3 and 5 years after operation were respectively 80. 6% ,48. 4% and 12. 9% in the opera-tion group while 14. 3% ,0. 0% and 0. 0% in the non - surgical group,and the difference was statistically significant (P < 0. 05). Survival rates of 1,3 and 5 years after operation were respectively 95. 2% ,62. 0% and 19. 0% in the radical surgery group while 50. 0% ,20. 0% and 0. 0% in the non - radical surgery group,the difference was statisti-cally significant( P < 0. 05). Multivariate analyses showed that TNM stage,degree of differentiation and surgical methods were independent predictive factors of survival for young patients. Conclusion:Gastric stump carcinoma mostly occured in the anastomotic and the anastomsis near after BillrothⅡstyle operation. Surgical treatment is the best way to improve the prognosis of gastric stump carcinoma. Radical resection appears to confer the only chance of prolonged survival.