外科治疗残胃癌九例临床分析

目的:分析残胃癌的临床治疗特点。方法:回顾分析1993~2005年收治的9例残胃癌临床资料。结果:本组手术切除率为100%,早期3例癌中1例行部分残胃切除术,2例行全残胃切除术;6例进行期癌中全残胃切除术4例,联合横结肠、脾切除术2例。早期癌病例3年生存率为100%;进行期癌中2例生存13个月,4例于确诊后6个月内死亡。结论:病期及手术治疗是残胃癌治疗预后好坏的关键。     

残胃癌的外科治疗（附14例分析）

目的：探讨残胃癌的外科治疗。方法：对14例残胃癌的外科治疗情况进行回顾性分析。结果：首次胃切除以胃溃疡为主，占71．4％，首次手术BillrothⅡ式占64．2%。残胃癌早期缺乏特异的症状，首次手术距临床确诊残胃癌的间隔时间平均为15年。结论：定期胃镜检查是早期诊断残胃癌的关键，根治性切除是治疗残胃癌的有效方法，病期及根治性切除是决定残胃癌预后的关键因素。     

残胃癌22例外科治疗分析

目的　探讨残胃癌的诊断方法和手术治疗方式。方法　对 2 2例残胃癌患者的临床资料进行回顾性分析。结果　残胃癌占同期胃癌的 1.5 % ,其中Ⅱ期 4例、Ⅲ期 6例、Ⅳ期 12例 ;有 3例 (13.6 % )施行姑息性手术 ,12例 (5 4 .5 % )施行根治性手术 ,7例 (31.8% )因肿瘤广泛转移而未行手术或仅行部腹探查术。根治性手术后 1、3、5年生存率分别为 80 .4 %、5 2 .1%、4 0 .9%。结论　定期胃镜和超声胃镜检查是残胃癌早期诊断的关键 ,根治性手术是治疗残胃癌的主要方法。     

残胃癌28例临床分析

目的:探讨残胃癌的早期诊断和手术治疗效果.方法:对28例残胃癌病人的临床资料进行回顾性分析,比较不同手术方式的生存率.结果:28例主要临床表现为上腹部胀痛,主要诊断方法是消化道钡餐和胃镜检查.其中21例行手术治疗,手术根治性切除的12例病人生存5年以上者7例,非限治手术的16例均在1年内死亡.结论:对胃部分切除术后病人定期随诊并胃镜检查有利于早期发现残胃癌.手术是其主要治疗手段,残胃癌根治性手术后的5年生存率近似于胃原发癌.早期诊断对提高残胃癌术后的生存率有重要意义.     

残胃癌的外科治疗体会

我科近10年来共收治胃癌960例,19例为残胃癌,占同期胃癌患者的051％。本文重点就其病因、外科治疗、消化道重建方法、预防措施进行讨论。l临床资料11一般资料19例中男16例,女3例,年龄27一月岁．平均年龄495岁。首次手术原因：胃溃疡5例,十二指肠溃疡10例,胃癌2例（la期低分化腺癌）,贵门癌2例（ma期溃疡型腺癌）。手术方式：B－1式2例,B－11式问例,附加布朗吻合1例。首次胃切除距第2次手术间隔时间3－27年,平均匕年。12第2次治疗情况残胃资门癌2例,残胃吻合口癌7例,残胃体癌10例。切除组门例（63．2叽）,其中根治性切除6例（3…     

残胃癌12例分析

残胃癌是胃、十二指肠良性病变胃部分切除术后远期的一个严重并发症。10年来,我院经内镜及病理证实12例,现报道如下。 1 临床资料 1.1 资料来源及方法 我院1980年1月～1992年6月做胃镜检查11080例,其中非手术胃患者10794例,检出胃癌433例(4.01％),而消化性溃疡(PU)胃次全切除术后5年以上患者126例中,检出残胃癌12例(9.52％),明显高于非残胃组(X~2=9.68,P<0.01),其中男10例,女2例;年龄34～68岁,平均46岁;胃溃疡(GU)术后36例,检出残胃癌5例(13.89％),十二指肠溃疡(DU)90例,检出残胃癌7例(7.78％),两组患者残胃癌检出率无显著性差异(x~2=1.114,P>0.05)。 1.2 诊断距首次手术时间和手术方式 5年零8个月～29年,平均13.6年,10年以上10例(83.33％),Billroth Ⅰ式2例,Billroth Ⅱ式10例。 1.3 临床表现、内镜及病理 无规律上腹疼痛6例,反复黑大便4例,消瘦、贫血2例;内镜所见:溃疡型6例,     

残胃癌33例和残胃再发癌15例的外科治疗和生存率分析

目的:探讨外科手术对残胃癌和残胃再发癌患者预后的影响。方法:回顾性分析我院外科1998年1月至2005年5月间收治的33例残胃癌和15例残胃再发癌患者的临床资料,按肿瘤分期及病理类型和外科手术方式进行分组,采用Kaplan-Meier方法绘制生存曲线,进行累计生存率的比较。结果:本组48例患者中,早期癌9例,进展期癌39例;手术切除率为72.9%,其中根治性切除23例(47.9%),姑息性切除12例(25.0%),早期癌与进展期癌,根治性切除与姑息性切除,分化型腺癌与未分化型腺癌比较,术后5年累积生存率均有统计学意义(P<0.01)。结论:定期胃镜复查和合理的根治性手术是提高残胃癌和残胃再发癌患者生存期的有效方法。     

残胃癌28例

残胃癌,是指胃、十二指肠良性疾病而行胃大部切除术后5年以上或胃癌术后5年以上残胃发生的癌,前者称原发性残胃癌,后者称继发性残胃癌。 1 临床资料 男22例,女6例。男:女=3.7:1;年龄最小者47岁,最大者71岁,平均58.5岁;以60～70岁多见。首次手术与残胃癌平均间隔时间为14.7年,最短者在术后5年,最长者在术后27年,多发生在术后10年以上。     

残胃癌33例和残胃再发癌15例的外科治疗和生存率分析

目的：探讨外科手术对残胃癌和残胃再发癌患者预后的影响。方法：回顾性分析我院外科1998年1月至2005年5月间收治的33例残胃癌和15例残胃再发癌患者的临床资料，按肿瘤分期及病理类型和外科手术方式进行分组．采用Kaplan-Meier方法绘制生存曲线，进行累计生存率的比较。结果：本组48例患者中，早期癌9例．进展期癌39例；手术切除率为72．9％，其中根治性切除23例（47.9％），姑息性切除12例（25.0％），早期癌与进展期癌．根治性切除与姑息性切除，分化型腺癌与未分化型腺癌比较，术后5年累积生存率均有统计学意义（P〈0．01）。结论：定期胃镜复查和合理的根治性手术是提高残胃癌和残胃再发癌患者生存期的有效方法     

残胃癌的诊断和治疗

残胃癌系指因胃良性疾患行胃部分切除术5～10年以上残胃再发生的癌。也有人将胃恶性肿瘤术后20年以上残胃再发生的癌列为残胃癌。我科自1987年6月至1995年8月共收治残胃癌13例,占同期胃癌的4.88％。报道如下。 1 临床资料 1.1 一般资料:13例均为男性,年龄30～70     

残胃癌36例治疗分析

目的分析和总结 36例残胃癌的诊断与手术治疗结果.方法回顾性分析 1990～ 2002年我院收治的 36例残胃癌患者的临床表现及治疗情况,并对手术方法、术后生存率进行总结与讨论.结果 36例残胃癌 1、3、5年生存率分别为 61.1%、36.1%、19.4%,其中作根治性手术 1、3、5年生存率分别为 82.3%、47.1%、35.3%.结论残胃癌临床症状缺乏特异性,早期诊断、早期治疗是提高预后的关键.联合脏器切除是残胃癌最有效的手术方法.     

Appraisal of gastric stump carcinoma and current state of affairs

Gastric stump carcinoma, also known as remnant gastric carcinoma, is a malignancy arising in the remnant stomach following gastrectomy for a benign or malignant condition. Enterogastric reflux and preexisting risk factors in a patient with gastric cancer are the major contributors to the development of gastric stump carcinoma. The occurrence of gastric stump carcinoma is time-dependent and seen earlier in patients operated on for malignant rather than benign diseases. The tumor location is predominantly at the anastomotic site towards the stomach. However, it can occur anywhere in the remnant stomach. The pattern of lymph node involvement and the type of surgery required is distinctly different compared to primary gastric cancer. Gastric stump carcinoma is traditionally considered a malignancy with a dismal outcome. However, recent advances in diagnostic and therapeutic strategies have improved outcomes. Recent advances in molecular profiling of gastric stump carcinoma have identified distinct molecular subtypes, thereby providing novel therapeutic targets. Also, reports of gastric stump carcinoma following pancreatoduodenectomy and bariatric surgery highlight the need for more research to standardize the diagnosis, staging, and treatment of these tumors. The present review aims to provide an overview of gastric stump carcinoma highlighting the differences in clinicopathological profile and management compared to primary gastric carcinoma.     

青年胃癌136例临床病理特点及预后观察

目的：分析青年胃癌患者的临床病理特征,探讨影响预后的因素。方法：回顾性分析2000年5月—2005年1月间行胃癌手术治疗的年龄≤45岁的青年患者136例的临床资料。结果：青年人胃癌临床表现以腹上区疼痛不适最常见,占72.1%,男女之比为1∶1.66,肿瘤部位以胃窦部常见,肿瘤分期Ⅲ～Ⅳ期120例,占88.2%;患者原发灶穿透浆膜（T3-4）114例,占全组的83.8%;Borrmann分型以浸润型（Ⅲ型＋Ⅳ型）为主,共110例,占80.9%;全组平均生存期为28.81个月,全组1,3,5年生存率分别为57.3%,25.7%和20.5%。结论：青年胃癌以女性和弥漫型癌所占比例较高,临床分期晚,根治性手术切除率低。TNM分期、手术性质及术后辅助化疗是评价其预后的重要参考因素。     

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.     

残胃癌的临床特征及外科治疗

目的探讨残胃癌的临床特征及治疗方法.方法回顾分析2000年1月至2010年12月上海新华医院普外科收治的32例残胃癌患者的临床资料.结果 32例患者确诊残胃癌距首次手术时间平均为21年;初次手术行Billrotn II式胃大部切除术24例;残胃癌发生在吻合口18例;残胃手术切除率为73.3%.结论 残胃癌大多发生于初次胃部分切除术后10年以上,多发生于Billroth II术式,癌病变主要位于吻合口附近.早期诊断、早期治疗,根治性手术是残胃癌的有效治疗方法.     

75岁以上老年食管癌、贲门癌的外科治疗

目的总结75岁以上高龄食管癌、贲门癌患者的临床特点及手术治疗经验。方法回顾性分析本院2006年1月—2010年12月间接受手术治疗的140例75岁以上高龄食管癌、贲门癌患者的临床资料。结果本研究无手术死亡病例。术后发生并发症43例,除1例呼吸衰竭难以纠正外,均经保守治疗后痊愈。随访1~5年,失访6例。术后1年生存率88.3%(121/137),3年生存率54.7%(47/86),5年生存率37.8%(14/37)。死亡患者中与原发病相关者和非原发病相关者分别为49例和15例。结论高龄食管癌、贲门癌患者体质较弱,常合并有其他多系统病症。细致的手术治疗和全面的围术期处理,可使大部分患者顺利度过围术期,取得满意疗效。     

SIRT2在胃癌组织中的表达与临床预后的关系

目的探讨胃癌组织中SIRT2的表达及其与临床病理特征及预后的相关性,并初步研究SIRT2在胃癌细胞中的作用。方法采用Western-blot法检测胃癌组织和癌旁正常胃黏膜组织中SIRT2蛋白表达的差异;用免疫组织化学法,检测100例胃癌组织及癌旁正常胃黏膜组织中SIRT2的表达情况,分析其表达水平与临床病理特征及预后的关系;将SIRT2-siRNA质粒转染胃癌细胞,通过Transwell实验观察下调SIRT2表达对胃癌细胞迁移侵袭能力的影响。结果 SIRT2在胃癌组织和癌旁正常胃黏膜组织中阳性表达率分别为67%(67/100)、16%(24/100),差异有统计学意义(P0.01);胃癌组织中SIRT2的高表达与胃癌的淋巴结转移、临床分期及患者预后显著相关;体外细胞实验显示下调SIRT2表达可抑制胃癌细胞的迁移和侵袭。结论 SIRT2可作为判断胃癌患者预后的一个独立指标,并有潜力成为一个胃癌靶向治疗的新靶点。     

食管胃双源病变的外科治疗

目的探讨食管胃双源病变的外科治疗方法及术式选择。方法回顾分析2008年5月~2012年1月本院食管胃双源病变患者12例的临床资料。结果 12例均行手术治疗,6例行右胸、腹二切口,3例行左胸切口,2例行左胸、腹联合切口,1例行左颈右胸腹三切口;10例行胃代食管术,1例行食管空肠Roux-en-Y吻合术,1例行结肠代食管术,术后瘘发生率16.7%。结论食管胃双源病变,积极的手术治疗是安全可行的,常用的代食管器官是胃,胃无法代食管,可用空肠、结肠代食管。     

Clinicopathological characteristics and prognosis of gastric signet ring cell carcinoma

BACKGROUNDThe clinicopathological features and prognosis of gastric signet ring cell carcinoma (GSRC) remain controversial, particularly with regard to sensitivity to postoperative adjuvant therapy.AIMTo compare the pathological features of GSRC with those of gastric adenocarcinoma of different degrees of differentiation and the differences in survival prognosis between the different disease processes.METHODSBy screening gastric cancer patients from 2010 to 2015 in the database of Surveillance, Epidemiology and End Results, and collecting the clinicopathological and prognostic data of gastric cancer patients who underwent surgery from January 2014 to December 2016 in the Second Affiliated Hospital of Nanchang University, we analyzed the general pathological characteristics of GSRC by the chi-square test. Univariate and multivariate analyses were conducted to compare the factors affecting the survival and prognosis of early and advanced gastric adenocarcinoma. The Kaplan-Meier curves were plotted to reveal the survival difference between early and advanced GSRC and different differentiated types of gastric adenocarcinoma. The prognosis model of advanced GSRC was established with R software, and the area under curve (AUC) and C-index were used to assess the accuracy of the model.RESULTSAnalysis of pathological features revealed that signet ring-cell carcinoma (SRC) was more frequently seen in younger (< 60 years), female, and White patients compared to non-SRC patients. SRC was less commonly associated with early gastric cancer (EGC) (23.60% vs 39.10%), lower N0 (38.61% vs 61.03%), and larger tumour sizes > 5 cm (31.15% vs 27.10%) compared to the differentiated type, while the opposite was true compared to the undifferentiated type. Survival prognostic analysis found no significant difference in the prognosis of SRC patients among EGC patients. In contrast, among advanced gastric cancer (AGC) patients, the prognosis of SRC patients was correlated with age, race, tumour size, AJCC stage, T-stage, and postoperative adjuvant therapy. The predictive model showed that the 3-year AUC was 0.787, 5-year AUC was 0.806, and C-index was 0.766. Compared to non-SRC patients, patients with SRC had a better prognosis in EGC [hazard ratio (HR): 0.626, 95% confidence interval (CI): 0.427-0.919, P < 0.05] and a worse prognosis in AGC (HR: 1.139, 95%CI: 1.030-1.258, P < 0.05). When non-SRC was divided into differentiated and undifferentiated types for comparison, it was found that in EGC, SRC had a better prognosis than differentiated and undifferentiated types, while there was no significant difference between differentiated and undifferentiated types. In AGC, there was no significant difference in prognosis between SRC and undifferentiated types, both of which were worse than differentiated types. A prognostic analysis of postoperative adjuvant therapy for SRC in patients with AGC revealed that adjuvant postoperative radiotherapy or chemotherapy significantly improved patient survival (34.6% and 36.2% vs 18.6%, P < 0.05).CONCLUSIONThe prognosis of SRC is better than that of undifferentiated type, especially in EGC, and its prognosis is even better than that of differentiated type. SRC patients can benefit from early detection, surgical resection, and aggressive adjuvant therapy.     

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。