45例残胃癌诊治的临床分析

目的:探讨残胃癌的临床病理特征,诊治方法及预后相关因素.方法:分析我院近20年来收治的45例残胃癌的临床病理资料.结果:残胃癌位于吻合口28例,贲门9例,其它部位8例;组织学类型:未分化腺癌1例;低分化腺癌36例;中分化腺癌7例;高分化腺癌1例.根治性切除组1、3、5年生存率分别为100%、78.8%、47.2%;非根治性切除组非治愈性切除患者的1、3、5年生存率分别为62.5%、25.0%和0.未切除的10例患者,均于2年内死亡,平均生存时间为12个月.各期病例5年生存率分别为Ⅰ期100.0%、Ⅱ期75.0%、Ⅲ期17.8%、Ⅳ期0.结论:残胃癌多发生于BillrothⅡ式胃大部切除术后10年以上.残胃癌的预后与病理分期和能否行根治性切除密切相关.     

胃癌根治术后残胃复发的外科治疗和预后分析

目的 探讨胃癌根治术后残胃复发癌的可切除性和预后影响因素。方法 对1995年至2004年间接受手术治疗的胃癌根治术后残胃复发的25例患者进行回顾性研究。结果 病例的根治性切除率为40％（10／25）。合并腹膜复发者无1例获得根治性切除。非吻合口处残胃复发的根治切除率为545％（6／11），吻合口处残胃复发者为28．6％（4／14）。获得根治切除患者的5年生存率为25．7％，未获得根治切除者为0。结论 残胃复发癌不能被根治切除的主要原因是同时合并腹膜复发或肿瘤复发侵犯周围重要脏器。吻合口处的复发肿瘤的根治性切除率有减低的趋势。复发肿瘤能否被根治切除、是否合并腹膜复发直接影响患者的预后。     

49例胃癌根治术后残胃复发的外科治疗和预后分析

目的：探讨胃癌根治术后残胃复发癌的可切除性和预后影响因素，方法：对1986～2002年间在我院接受手术治疗的胃癌根治术后残胃复发的49例患者进行回顾性研究。结果：本组病例的根治性切除率为36．7％(18／49)。合并腹膜复发者无1例获得根治性切除。非吻合口处残胃复发的根治切除率为45．5％(10／22)，吻合口处残胃复发者为29．6％(8／27)。获得根治切除患者的5年生存率为26．7％，未获得根治切除者为0。未合并腹膜复发患者的5年生存率为15．6％，合并腹膜复发者为0，结论：残胃复发癌不能被根治切除的主要原因是同时合并腹膜复发．或肿瘤复发侵犯周围重要脏器，吻合口处的复发肿瘤的根治性切除率有减低的趋势．复发肿瘤能否被根治切除、是否合并腹膜复发直接影响患者的预后。     

残胃癌的外科治疗与预后分析

背景与目的：残胃癌具有独特的生物学活性,外科治疗复杂,预后差。本研究主要探讨残胃癌的临床特点、治疗方法对远期生存率的影响,分析影响预后的因素。方法：回顾性分析浙江省肿瘤医院1990年1月至2007年12月收治的81例残胃癌的临床资料。用Kaplan—Meier法进行生存分析,用Cox回归模型进行多因素分析。结果：81例残胃癌中,根治性手术切除治疗47例,非根治性治疗（包括姑息性切除术、短路或造瘘术及探查术）34例,根治手术切除率为58．0％。全组1、3、5年总生存率分别为69．1％、24-3％、11．8％。根治组患者1、3、5年生存率分别为93．6％、42．0％、20．8％,非根治组1、3、5年生存率分别为35．3％、5．9％、0％,两组相比差异有统计学意义（P〈0．05）。Cox多元回归分析显示,残胃癌术后生存率与肿瘤的病理类型、病期、根治情况、腹膜种植、肝转移等因素有关。结论：合理的根治性手术可提高残胃癌患者的生存率。肿瘤的病理类型、TNM分期、根治情况、腹膜种植、肝转移是影响预后的独立因素。     

残胃癌43例临床病理分析

目的：探讨残胃癌的临床及病理特点，方法：对43例残胃癌临床病理资料进行回顾性分析。结果：43例残胃癌患者临床症状以腹痛，腹胀，黑便，吞咽困难为主要表现；首次手术方式：胃切除比Ⅱ式吻合32例（74．4％），胃切除毕I式吻合11例（25．6％），距首次手术发生残胃癌时间为5－25年，平均12年，发生部;钱胃吻合口25例（58．1％），残胃贲门15例（34．9％，其中3例同时侵犯食管下段），残胃小弯侧癌3例，组织学类型，高分化腺癌6例（13．9％），中分化腺癌6例（13．9％），低分化腺癌21例（48．8％），未分化癌6例（13．9％），黏液腺癌4例（9．3％），25例出现邻近脏器，组织（肝，胰，脾，肠系膜，网膜）转移（58．1％），无转移者18例（41．9％），其中5例癌组织局限在黏膜层及黏膜下层，结论：残胃癌多发生于胃切除毕II式吻合术后，胃大部切除术后定期随访，必要时做胃镜检查及病理活检可早期发现残胃癌，有效的治疗能延长残胃癌患者的生存期。     

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。     

14例残胃癌的临床分析

回顾性分析了1987年4月－2000年4月，枣庄市市中区人民医院收治的14例残胃癌患者的临床病理资料。根治性切除6例（42．9％），3年生存率50．0％（2／4），5年生存率25．0％（1／4）；姑息性切除4例（28．6％），3年生存率33．3％（1／3），无5年生存者。结果提示，手术切除是提高残胃癌患者生存率的关键之一。     

全胃切除消化道重建术式临床应用

1985年1月－1996年12月对胃体癌、贲门胃底癌、胃内多原发癌、胃内癌灶达两个分区及残胃癌行全胃切除术。其中根治性切除73例,姑息性切除21例,全组死亡3例,死亡率3．19％,术后1、3、5年生存率分别为71．28％,54．25％、43．61％。根治性切除组5年生存率为57．5％,姑息性切除5年生存率为20％。术后并发症发生10例,占10．64％,发生吻合口瘘1例,胰腺残端瘘1例,肠粘连肠梗阻1例,术后肺炎2例,泌尿系感染3例,对全胃切除的手术适应症,消化道重建及手术经路进行了讨论,认为间置空肠代胃术是较好的代胃术式,5、6月组淋巴结无转移病人行保幽门、间置空肠代胃术。     

残胃癌的外科治疗分析（附17例报告）

目的：探讨残胃癌外科治疗与预后。方法：对1990年1月～2003年12月收治的17例残胃癌病例进行回顾性分析。结果：本组残胃癌根治性切除率为76．47％，姑息性切除率为17．65％，根治性切除术后1年、3年、5年生存率分别为84．62％、46．15％、30．77％，2例失访，随访率88．24％。结论：早期诊断是残胃癌预后的关键，根治性全胃切除是残胃癌的主要治疗手段，亦是影响预后的重要因素。     

残胃癌28例临床诊治分析

目的 探讨残胃癌的临床病理特征,诊治方法 及预后相关因素.方法 回顾性分析28例残胃癌的临床资料.结果 28例残胃癌中,根治性切除及姑息性切除者1、3、5年生存率分别为93.3%、73.3%、46.7%及57.1%、14.3%、0,差异均有统计学意义(P<0.05).Ⅰ、Ⅱ、Ⅲ、Ⅳ期残胃癌5年生存率分别为100.0%、60.0%、18.2%、0,差异有统计学意义(P<0.05).全组5例发生术后并发症,经治疗后均痊愈.结论 胃镜下活检是诊断残胃癌的首要方法 ;残胃癌的预后与病理分期和能否行根治性切除术密切相关.     

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.     

胃大部切除术后食管癌的手术治疗

目的：探讨胃切除术后食管癌（Ｅｃａ）的手术治疗方式和效果。方法：对１９８７年～１９９６年间手术治疗８１５例Ｅｃａ中４１例胃切除后Ｅｃａ的手术治疗进行分析。１例胸下段Ｅｃａ行切除并残胃食管弓下吻合术，４０例右胸入路行右半结肠代食管术合并颈、胸、腹淋巴结清除术。结果：４１例胃切除术后Ｅｃａ颈、上纵隔、中下纵隔和腹部淋巴转移率分别为３４．１％、２１．９％和１９．６％。并发症发生率４８．７％。颈部吻合口瘘发生率３４．１％，无手术死亡。全组３、５年生存率４１．６％和１５．４％。根治性手术３、５年生存率４６．６％和２２．２％。姑息手术无１例生存超过５年。３年生存率１４．３％。结论：对胃切除术后Ｅｃａ颈、上纵隔和腹部淋巴结清扫很重要。结肠代食管术为安全有效办法。右半结肠经胸骨前、后径路代食管术是胃切除后Ｅｃａ手术的最好方法之一     

Safety of modified double-stapling end-to-end gastroduodenostomy in distal subtotal gastrectomy

BACKGROUND AND OBJECTIVES: Double-stapling end-to-end gastroduodenostomy (DS-BI) has several potential advantages over other anastomotic techniques in that it is a simple procedure, with no additional gastrotomy on the remnant stomach, and less tension on the anastomosis site. We evaluated the safety of DS-BI by comparing it with the hand-sewn Billroth II gastrojejunostomy (B-II). METHODS: Medical records of 933 consecutive patients (DS-BI 428, B-II 505) who underwent distal subtotal gastrectomy were retrospectively reviewed. Several clinicopathological features and treatment results were compared between the two groups. RESULTS: The overall complication rates were 9.3% in the DS-BI group and 15.2% in the B-II group (P = 0.007). Anastomosis-related complications, such as anastomosis-site leakage, stenosis, and intraluminal bleeding, did not differ between the two groups (1.2% in the DS-BI group and 1.8% in the B-II group, P = 0.59). All the anastomosis-related complications were managed conservatively. Postoperative mortality rates were 0% in the DS-BI group and 0.4% (2/505) in the B-II group. CONCLUSIONS: Modified DS-BI is a safe procedure, with short-term results similar to those of hand-sewn Billroth II anastomosis.     

残胃贲门癌42例外科治疗报告

目的探讨残胃贲门癌的外科治疗效果。方法回顾性分析42例残胃贲门癌外科治疗的临床资料。手术切除40例,探查2例,根治性切除32例,姑息性切除8例,残胃切除空肠代胃术36例,贲门肿瘤切除余胃食管吻合术4例。结果手术切除率95.2%（40/42）,无手术死亡,手术并发症11例（26.2%）。根治性切除32例中术后生存1年以上30例,3年以上18例,5年以上12例。1,3,5年生存率分别为93.8%、56.3%和37.5%。结论以外科手术为主的综合治疗是治疗残胃贲门癌的有效方法。     

Treatment and prognosis of early multiple gastric cancer.

AIM: Early gastric cancer (EGC) may have a 5-year survival rate of over 90% following surgery. Early multifocal gastric cancer (EMGC) accounts for between 8.3 and 17% of all EGCs. A multicenter retrospective study is reported of prevalence, characteristics, prognosis and type of resection for EMGC patients. METHOD: 333 patients with EGC were operated on, between January 1979 and December 1988, and followed to June 1996. RESULTS: 33 EGC patients had EMGC. There was no significant difference in clinico-pathological features between EGC and EMGC. 21 cases of EMGC underwent a subtotal gastrectomy and 12 underwent a total gastrectomy. Recurrences after subtotal gastrectomy were, respectively, 10 and 18% for EGC and EMGC patients (p=0.2). The cumulative 5 years specific survival rate for 298 EGC and 34 EMGC were 94 and 90%, respectively (p=0.9). Five-year survival rates after subtotal gastrectomy were 92 and 90% for EGC and EMGC patients, respectively (p=0.8). CONCLUSION: EGC and EMGC had the same clinico-pathological features and prognosis. A careful follow up of the stomach remnant is essential.     

胃癌根治术后局部或区域性复发部位规律及复发后放疗疗效在确定术后放疗靶区中的意义

目的:探讨胃癌根治术后肿瘤局部或区域性复发的部位及其规律以及放疗的价值,同时建立新的胃癌根治术后淋巴结分组方法以指导放疗靶区的确定.方法:回顾性分析2006年3月-2010年2月共43例胃腺癌根治术后发生局部或区域性复发的患者,均经影像学检查证实为胃癌根治术后复发,其中10例残胃或吻合口复发患者经病理组织学活检予以确诊.对43例患者的局部或区域性复发部位规律进行分析.结果:43例患者中,吻合口或十二指肠残端复发11例(25.6％),肿瘤床复发5例(11.6％),残胃复发2例(4.6％),区域淋巴结转移35例(81.4％).中位术后复发时间为胃癌根治术后15个月.放疗后的中位生存时间为15个月,1年生存率为59％,2年生存率为31％.N分期越高,术后复发时间越短.中位肿瘤缓解时间为14个月,且与复发部位(P=0.023)和性别(P=0.038)有关.通过拟定新的胃癌根治术后淋巴结转移区域分区方法(包含Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ和Ⅵ区),指导放疗靶区的确定和勾画.结论:胃癌根治术后局部或区域性复发部位主要包括吻合口、十二指肠残端、肿瘤床、残胃和区域淋巴结,其中淋巴结转移是主要的肿瘤复发方式(主要发生在Ⅰ、Ⅲ和Ⅵ区).新的胃癌根治术后淋巴结转移区域分区方法能够指导放疗靶区的确定,在勾画放疗靶区时应包括上述区域.     

A clinicopathological study of recurrent gastric cancer cases treated by a resection of the remnant stomach

Seventeen cases of a recurrent gastric cancer that were treated by a resection of the remnant stomach have been studied retrospectively. For first management 12 cases were given a Billroth 2 procedure, 4 cases a Billroth 1 procedure and 1 case a fundectomy. For the recurrent cancer, 13 cases were given a total resection of the gastric remnant and 4 cases a partial resection. The overall mortality rate was 12% and the survival rate was 58% at 1 year, and 8% at 5 years. We thus have concluded that a resection of the remnant stomach should be carried cut in cases of a recurrent gastric cancer whenever possible.     

A new suggestion for the radiation target volume after a subtotal gastrectomy in patients with stomach cancer

PURPOSE: To compare treatment results between the use of two different radiation fields including and excluding remnant stomach and suggest new target volumes excluding remnant stomach after subtotal gastrectomy (STG) in patients with stomach cancer. METHODS AND MATERIALS: We retrospectively analyzed 291 patients treated with adjuvant chemoradiotherapy after STG and D2 dissection at the Samsung Medical Center, Seoul, South Korea. Eighty-three patients registered from 1995 to 1997 underwent irradiation according to the INT 0116 protocol that recommended the inclusion of remnant stomach within the target volume (Group A). After this period, we excluded remnant stomach from the target volume for 208 patients (Group B). Median follow-up was 67 months. RESULTS: Treatment failure developed in 93 patients (32.0%). Local and regional recurrence rates for Group A vs. Group B were 10.8% vs. 5.3% (p = not significant) and 9.6% vs. 6.3% (p = not significant), and recurrence rates for remnant stomach were 7.2% vs. 1.4% (p = 0.018), respectively. Overall and disease-free survival rates were not different between the two groups. Grade 3 or 4 vomiting and diarrhea developed more frequently in Group A than Group B (4.8% vs. 1.4% and 6.0% vs. 1.9%, respectively; p = 0.012; p < 0.001). CONCLUSION: Exclusion of remnant stomach from the radiation field had no effect on failure rates or survival, and a low complication rate occurred in patients treated excluding remnant stomach. We suggest that remnant stomach be excluded from the radiation target volume for patients with stomach cancer who undergo STG and D2 dissection.     

Risk analysis of carcinogenesis in the remnant stomach with measurement of ornithine decarboxylase activity

Gastric ornithine decarboxylase (ODC) activity was measured as a biomarker of tumor-promoting activity in the remnant stomach of rats and humans. Gastrectomy of Wistar rats utilizing the Billroth I method caused a significantly high induction of ODC, and use of the Billroth II method caused a significantly higher induction of ODC than the Billroth I method. In humans, ODC activity of remnant gastric cancer tissue, normal-appearing mucosa of remnant gastric cancer patient, and remnant gastric mucosa without cancer after the Billroth II method were significantly higher than that of normal gastric mucosa without gastrectomy. ODC activity of remnant gastric mucosa without cancer after the Billroth II method was significantly higher than that after the Billroth I method. Risk of carcinogenesis was high in the remnant stomach, especially after the Billroth II method. © 1994 Wiley-Liss, Inc.