残胃癌的临床病理特点及预后分析

目的 许多学者认为残胃癌切除率低,预后不佳.本研究通过与近端胃癌对比,了解胃良性疾病术后残胃癌的临床病理特点及预后.方法 回顾性分析1998-2008年间在我院施行手术的胃癌患者,其中残胃癌31例,近端胃癌144例,分析两组患者的临床病理特点、患者预后及影响预后的因素.结果 初次胃切除术后至确诊残胃癌的平均间隔时间为(16.87±4.30)年,残胃癌多位于吻合口(87.1%).与近端胃癌的患者相比,残胃癌患者的平均年龄较大,但肿瘤大小、分期、组织分型、浸润深度、淋巴转移、远处转移等临床病理特点及根治切除率均无显著性差异.残胃癌总体5年生存率为29.1%,与近端胃癌的39.7%无显著性差异(P＞0.05).根治手术的残胃癌患者5年生存率为38.3%,与近端胃癌差异无统计学意义.浸润深度和根治手术是本组残胃癌患者的独立预后因素.结论 残胃癌的临床病理特点及预后与近端胃癌相似.早期诊断、接受根治手术,可有效改善残胃癌患者的预后.     

可根治切除残胃癌的临床病理特征及预后

目的：分析可根治切除残胃癌临床病理特征及预后情况。方法回顾性分析1999年11月至2013年12月进行残胃癌根治切除术的63例患者的临床病理资料,按照初次手术方式和初次手术时疾病良恶性分组,分析比较残胃癌的临床病理特征及患者的长期生存率。结果按照初次手术疾病良恶性分组,残胃癌发病的间隔时间分别为24.8年和8.9年;肿瘤直径分别为6.9 cm和4.3 cm ,残胃癌位于吻合口的比例分别为50%和26.3%。按照初次手术方式（BillrothⅡ、BillrothⅠ）分组,残胃癌发病的间隔时间分别为22.8年和12.3年。肿瘤直径分别为6.73 cm和3.75 cm ,残胃癌位于吻合口的比例分别为52.4%和21%。以上各组进行比较,差异均具有统计学意义（均P＜0.05）。TNMⅠ～Ⅱ期与Ⅲ期患者80个月生存率分别为64.7%和18.5%,差异有统计学意义（P＜0.05）。初次手术良性组与初次手术恶性组,100个月累积生存率分别为37.1%和40%,差异无统计学意义（P＞0.05）。BillrothⅡ组与BillrothⅠ组,患者80个月累积生存率分别为43.1%和27.3%,差异无统计学意义（P＞0.05）。结论初次胃切除术时疾病良恶性、重建方式与残胃癌发病间隔时间、肿瘤大小、肿瘤好发部位等临床特点有关。可根治切除的残胃癌患者,其长期生存率与初次胃切除术时疾病良恶性、重建方式无关,与TNM分期有关。     

胃间质肿瘤临床诊治分析

目的探讨胃间质肿瘤的临床病理诊断、外科治疗以及预后.方法回顾分析8例经过外科手术治疗的胃间质肿瘤患者的临床病理资料.结果手术局部切除4例,类似于胃癌根治手术(D2)4例.良性6例,恶性2例,主要表现为胃黏膜下孤立性包块.绝大多数无黏膜破坏,有黏膜破坏者常常较大并且伴有深入肿瘤的窦道.手术后病理检查无淋巴结转移.免疫组织化学CD117阳性5例,CD34阳性4例.结论肿瘤大体的生长特点有助于该病的诊断及手术治疗方式的选择,细胞学和免疫组织化学可以明确诊断,预后较好.     

残胃癌与初发胃癌外科治疗及预后的比较研究

目的:回顾分析残胃癌与初发胃癌手术治疗及预后的差异.方法:对我院2000-01-2007-12收治的残胃癌根治手术切除患者69例,并取同期手术治疗的初发胃癌69例做对照研究.结果:残胃癌组和胃癌组相比,手术时间[(225.4±34.9) min vs(184.0±30.9)min]、术中出血[(416.8±338.6)mL vs(227.8±185.3)mL]、联合脏器切除率(30.43％ vs 4.35％)、术后并发症(27.54％ vs 7.25％)、术后住院时间[(15.4±5.6) d vs(12.5±3.8)d]的差异有统计学意义,P＜0.05;而清除淋巴结数目[(17.3±5.6)枚vs(17.9±6.4)枚]、3年生存率(40.6％ vs 53.6％)相比差异无统计学意义,P＞0.05.结论:残胃癌手术难度较大、并发症高,术后住院时间长,但其预后与初发胃癌无差异.     

磷酸化survivinThr34蛋白在胃良恶性病变组织中表达的研究

目的 探讨磷酸化survivinThr34蛋白在胃良恶性病变组织中的表达及其意义.方法 采用免疫组化方法,检测108例手术切除和内窥镜活检的胃部良恶性病变组织中磷酸化survivinThr34的表达情况.结果 胃腺癌组织磷酸化 survivinThr34 蛋白的表达率为76.79%,且与患者的性别、年龄、组织分化程度、病理分期无关,分别与胃不典型增生组织(33.33%)和胃良性病变组织(35.29%)磷酸化 survivinThr34 蛋白表达率比较,有显著性差异(P＜0.01),但后两者比较无显著性差异(P＞0.05).结论 磷酸化的survivinThr34 在胃腺癌中表达明显增高,可作为胃癌诊断的参考指标之一.     

残胃癌的临床病理特征及预后分析

目的探讨残胃癌的临床病理特征及预后相关因素。方法回顾性分析45例残胃癌患者的临床病理资料,并进行随访。结果45例残胃癌患者的男女比例为44：1。初次手术距残胃癌的诊断时间为5～42年,平均23年。残胃病变位于吻合口28例,位于贲门9例,其余部位8例。未分化癌1例,低分化腺癌36例,中分化腺癌7例,高分化腺癌1例。根治性切除患者的1、3、5年生存率分别为100．0％、78．8％和47．2％,非根治性切除患者的1、3、5年生存率分别为62．5％、25．0％和0,两组患者生存率差异有统计学意义（P〈0．05）。10例病变未切除患者均于2年内死亡,平均生存时间为12个月。各病理分期患者间生存率差异有统计学意义（P〈0．05）。结论残胃癌多于Billroth Ⅱ式胃大部切除术后10年以上发生,男性多于女性,病变主要位于吻合口附近。进展期残胃癌病理类型以低分化腺癌常见。残胃癌的预后与病理分期、能否行根治性切除密切相关。     

残胃癌20例临床分析

残胃癌是指因各种原因行胃部手术（良性病变术后５年以上，恶性病变术后１０年以上且初次手术病理检查排除癌残留）后发生在残胃内的原发癌〔１〕，华西医大附一院１９８７．３～１９９４年１２月间共收治残胃癌２０例，现结合有关资料报告如下。临床资料本组２０例，男１...     

残胃贲门癌诊治17例报告

残胃贲门癌是指胃十二指肠良性病变行胃部分切除 ,胃空肠吻合术后或胃癌根治术后 5年以上 (已排除转移 ) ,在残胃贲门部位发生的原发性恶性肿瘤 [1 ,2 ] ,我院自 1970年至今共收治该类患者 17例 ,现就诊治中的几个问题进行探讨。1　临床资料1.1　一般资料　男性 11例 ,女性 6例 ,年龄 41岁～ 72岁 ,平均年龄 5 2 .7岁。1.2　首次手术情况　胃或十二指肠球部溃疡 14例 ,胃癌 3例 ,2次手术时间间隔 6年～ 2 1年 ,首次手术术式 :B 式6例 ,B 式 11例。1.3　再次手术情况　本组 17例 ,术前均经胃镜及病理检查明确诊断 ,手术经左胸第 7肋间进胸 ,…     

p53和KAI1在胃癌中的表达及临床意义

目的探讨胃癌中p53和KAI1蛋白表达的相关性及其与胃癌侵袭转移的关系.方法免疫组化S-P法检测p53和KAI1的表达.结果胃癌组织中KAI1蛋白的阳性率显著低于胃正常组织(P＜0.01),p53蛋白阳性率显著高于胃正常组织(P＜0.01).KAI1与胃癌的临床分期、病理分化程度及转移呈负相关(P＜0.05).p53与胃癌的临床分期、病理分化程度及转移呈正相关(P＜0.05).p53和KAI1表达之间无明显相关(P＞0.05,rc=0.025).结论p53和KAI1蛋白的检测可用于胃癌转移预测、恶性程度评估和预后判断.p53可能并不直接调控KAI1在胃癌中的表达.     

p27Kip1在胃癌中的表达及意义

目的研究p27蛋白在胃癌中的表达及其与临床病理学特征的关系.方法应用SP免疫组化法,对20例胃良性病变标本及62例胃癌组织p27的表达及其与临床病理学特征的关系进行分析.结果p27在胃良性病变中的阳性率为100%(20/20),而在胃癌中的阳性率为41.9%(26/62),p27在两组织中的表达差异有显著性(P＜0.05);p27的阳性表达在未累及浆膜及淋巴结未转移者显著高于累及或穿透浆膜及有淋巴结转移者(P＜0.05).结论p27参与胃癌的进展,可能是一个预测胃癌预后的重要因素.     

Early and late gastric cancer arising in the remnant stomach after distal gastrectomy

AIM: Following distal gastrectomy, carcinogenesis has been suggested to result from gastroduodenal reflux. In this study, surgical cases of gastric cancer arising after distal gastrectomy were analyzed clinico-pathologically and the possible link to reflux examined. PATIENTS: Thirty-two patients (24 males, 8 females; mean age, 68.7 years; age range, 33-84 years) with gastric cancer arising in the remnant stomach after gastrectomy (also known as gastric stump cancer) were included in this study. Patients were divided into two groups on the basis of the initial diagnosis (benign or malignant) prompting surgery, and distal gastrectomy reconstruction method (Billroth I or II). RESULTS: The interval between distal gastrectomy and detection of cancer in the remnant stomach of patients treated initially for a benign gastric condition vs. malignancy was 360+/-33.04 and 63+/-19.16 months (median+/-SE), respectively (p<0.0001). However, the benign and malignant groups did not differ significantly in the clinicopathological analysis of their stump cancers. All 10 patients in whom gastric cancer was diagnosed within five years of initial surgery had initially been surgically treated for malignancy. The interval between surgery and detection of gastric cancer in the Billroth I and Billroth II groups was 84+/-26.67 and 276+/-44.26 months (median+/-SE), respectively (p<0.01). In the remnant stomach, cancer tended to occur near the site of gastrojejunostomy in the Billroth II group (p=0.05). Helicobacter pylori infection was only detected histologically in four patients who had undergone Billroth I reconstructions after distal gastrectomy for malignancy. CONCLUSION: After distal gastrectomy, careful periodic endoscopic examination for microcarcinoma is required in patients, particularly in those who undergo surgery for malignancy, to maximize detection of gastric cancer.     

残胃癌的临床诊断和外科治疗

目的:总结残胃癌的临床诊断和改进残胃癌的外科治疗效果。方法:回顾性分析我科1995年1月-2005年12月间收治的36例残胃癌的发病情况、临床表现及治疗结果。结果:首次胃切除病因以消化性溃疡为主(35例,占97.2%),首次手术B-Ⅱ式29例,占80.6%。确诊残胃癌距首次胃切除手术时间平均为17.5年。残胃癌发生于胃肠吻合口者占58.0%,发生于残胃小弯者占35.9%,发生于贲门者占6.1%,根治性切除手术占58.3%(21例)。结论:良性胃十二指肠病变行胃切除手术治疗时应以B-Ⅰ式或Roux-en-Y吻合为首选,B-Ⅱ式吻合需加Braun吻合较为合理。对残胃癌高危人群应定期行胃镜检查,早期诊断、早期根治性手术切除是提高残胃癌预后的关键。     

残胃癌的临床诊断和外科治疗

目的：总结残胃癌的临床诊断和改进残胃癌的外科治疗效果。方法：回顾性分析我科1995年1月-2005年12月间收治的36例残胃癌的发病情况、临床表现及治疗结果。结果：首次胃切除病因以消化性溃疡为主（35例,占97.2%）,首次手术B-Ⅱ式29例,占80.6%。确诊残胃癌距首次胃切除手术时间平均为17.5年。残胃癌发生于胃肠吻合口者占58.0%,发生于残胃小弯者占35.9%,发生于贲门者占6.1%,根治性切除手术占58.3%（21例）。结论：良性胃十二指肠病变行胃切除手术治疗时应以B-Ⅰ式或Roux-en-Y吻合为首选,B-Ⅱ式吻合需加Braun吻合较为合理。对残胃癌高危人群应定期行胃镜检查,早期诊断、早期根治性手术切除是提高残胃癌预后的关键。     

残胃癌12例报道

上海医科大学肿瘤医院１９７０～１９９２年２２年间收治残胃癌１２例，男性１１例，女性１例，平均年龄５５．０岁。因胃良性病变行胃大部切除者９例。确诊日期距首次手术的时间平均为１０．３年；因胃恶性疾病行胃癌根治术者３例，距首次手术的时间平均为８．７年，１０例行手术治疗，切除８例（６６．７％），探查２例（１６．７％），另２例已有远处转移而未行手术（１６．７％）。手术切除组生存５年以上者４例。本文讨论了残胃癌的临床表现、胃镜检查及手术治疗，及早期诊断的重要性。     

中青年与老年胃癌术后患者的临床病理特点和预后因素—基于SEER数据库的分析

目的:比较中青年与老年胃癌患者的临床病理特征,分析胃癌根治术后影响中青年和老年胃癌患者长期生存的预后因素。方法:选取SEER数据库经胃癌根治手术治疗后的胃癌患者,用方差分析分析胃癌不同原发部位的肿瘤大小差异,采取COX比例风险模型、卡方检验和Kaplan-meier法,对患者资料进行分析。结果:两组胃癌患者在性别、组织学类型、T分期、分化程度、婚姻情况等方面比较,差异均有统计学意义（P＜0.05）。与老年胃癌组相比,中青年胃癌组中男性发生率高,出现印戒细胞癌的比例高,且低分化或未分化所占比例都高于老年胃癌组。年龄是影响胃癌根治术后患者生存期的独立危险因素。种族、肿瘤原发部位、T、N、M分期、肿瘤大小均是影响中青年胃癌患者生存时间的相关因素（P＜0.05）,肿瘤大小、T、N、M分期是影响中青年胃癌患者生存期的独立危险因素（P＜0.05）。种族、肿瘤原发部位、分化程度、组织学类型、T、N、M分期、肿瘤大小、婚姻情况均是影响老年胃癌患者生存时间的相关因素（P＜0.05）,肿瘤大小、T、N、M分期是影响老年胃癌患者生存期的独立危险因素（P＜0.05）。胃癌不同原发部位的肿瘤大小之间的差异无统计学意义（P＞0.05）。结论:年龄与胃癌的临床病理特征关系密切,不同年龄具有不同发病特点,且年龄是影响胃癌根治术后患者生存期的独立危险因素。淋巴结的转移度、肿瘤的侵犯深度、肿瘤的大小、远处转移均是中青年和老年胃癌患者预后的重要因素,强调早诊早治,是提高胃癌患者预后的关键。     

Gastric stump carcinoma - epidemiology and current concepts in pathogenesis and treatment.

AIM: The aim of this article is to review the aetiology, pathology and treatment of gastric stump carcinoma (GSC). GSC is an uncommon tumour; however, the incidence is not declining, so this tumour entity will be encountered in the years to come. METHODS: The electronic literature search was performed in the MEDLINE database to identify relevant studies concerning epidemiology, prognosis, treatment, aetiology and pathology of GSC. The references reported in these studies were used to complete the literature search. RESULTS: Patients subjected to distal gastric resection have a 4-7-fold increased risk of developing GSC, which is attributed mainly to gastroduodenal reflux. Denervation during partial gastrectomy may also contribute to the risk of developing GSC. Gastroduodenal ulcers were the main reason for partial gastrectomy. Both ulcer locations have an increased risk of developing GSC after 20 years. In GSC, Helicobacter pylori seems not to be an important risk factor, contrary to primary gastric cancer, because gastroduodenal reflux impairs the growth of Helicobacter pylori. CONCLUSION: The treatment of choice for GSC should be the total removal of the gastric remnant including at least D2 lymphadenectomy. The pattern of lymph node metastases in GSC may differ from primary gastric cancer, as lymph node metastases have been reported in the jejunal mesentery and the lower mediastinum. Therefore, GSC may require a modified lymphadenectomy to include all important lymph node stations. After radical remnant gastrectomy, GSC has a prognosis not different from primary proximal gastric cancer.     

胃癌根治术后手术部位感染影响因素及血清 MCP1、CA72-4、sCD14水平变化意义分析

目的:探究胃癌根治术后手术部位感染(surgical site infection, SSI)影响因素及血清单核细胞趋化蛋白-1(monocyte chemoattractant protein-1,MCP1)、糖类抗原72-4(carbohydrate antigen 72-4,CA72-4)、可溶性白细胞分化抗原-14(soluble cluster of differentiation antigen-14,sCD14)水平变化意义。方法:选取2017年02月至2021年01月我院150例行胃癌根治术患者作为研究对象,根据患者术后是否出现SSI分为两组,感染组(n=35)与非感染组(n=115)。比较两组患者临床资料、手术前后血清MCP1、CA72-4、sCD14水平,分析胃癌根治术后SSI影响因素。绘制受试者工作特征曲线(receiver operating characteristic curve, ROC),评价胃癌根治术后血清MCP1、CA72-4、sCD14水平对SSI的诊断价值。分析术后血清CP1、CA72-4、sCD14水平与感染程度(IPS评分)的相关性。比较术后...     

Cystosarcoma phyllodes of the breast

Forty-nine patients with cystosarcoma phyllodes (CP), aged 13-81 years, (mean 35.2 years) were studied. Tumor size ranged from 1.9 to 14 cm (mean 5.2 cm). Mean follow-up period was 11.3 years. Tumors were histopathologically graded as benign, borderline or malignant. Forty-two tumors were diagnosed as benign; 4 borderline and 3 malignant. Six patients had recurrent disease within 6 years of their first surgery. Statistical analysis showed that age was not a significant factor for predicting recurrence or malignant histopathology. Five patients with relapse had borderline or malignant tumors larger than 4 cm. The histopathologic diagnosis was concordant with the clinical course. Multivariate analysis showed that tumor size and histology were significant and independent factors for disease-free interval. Breast-conserving surgery with a wide tumor-free margin is preferred in CP, and close follow-up is advised in cases with malignant or borderline histopathology and tumors larger than 4 cm.     

Studies on carcinoma of the remnant stomach after distal gastrectomy

Sixty-one patients with carcinoma of the remnant stomach after distal gastrectomy were admitted by the end of 1982. Twenty-six of them were gastrectomized for benign disease such as peptic ulcer and 35 for malignant disease such as gastric carcinoma. The age of the benign group was 58, and the average interval from the first operation was 19 years. The corresponding figures for the malignant group were 63 and 8 years, respectively. In the malignant group, the methods of anastomosis at the first operation were 18 cases of Billroth-I (B-I) and 17 of B-II. The lesion was located at the surgical stump in 7 patients and distant from the stump in 14 patients in this group. In the benign group, there were 10 cases of B-I and 16 of B-II, and no differences were seen in the location. Early carcinoma was noted in 11 patients, and 34 were advanced. Differentiated adenocarcinoma was observed in 25 cases and undifferentiated in 20 in the resected specimen. Although no metastases were seen in early cases, the rate of lymph node metastasis was 70%, and the five-year survival rate was 21% in advanced cases, and 80% in early cases.