残胃癌的外科治疗与预防(附36例病例分析)

目的探讨残胃癌早期诊断、外科治疗与预防。方法回顾分析1995年1月～2005年1月收治的36例残胃癌发病率、临床表现及治疗情况。首次手术方式均为毕II式吻合;间隔时间10～35年。结果23例行残胃癌根治术病人的1年、3年、5年累积生存率分别为78.26%、34.80%和26.10%。4例未手术和9例行姑息性手术者均于一年内死亡。若将这23例分为残胃全切除(n=15)和残胃次全切除(n=8)两组,前者的1年、3年、5年生存率分别为80.00%、66.70%和62.50%,而后者1年、3年的生存率为75.00%和33.33%,无一例生存逾5年。两者比较有显著性差异(P<0.01)。结论早期发现、早期诊断对提高残胃癌的手术切除率有重要意义,是提高生存率的关键。手术以根治术为主,无论是早期还是进展期残胃癌均提倡全胃切除。清扫一般包括癌肿周围第1站和第7、8、9、10、11、12、13组淋巴结,同时清除空肠系膜根部第14组淋巴结。重视残胃癌预防,应采取积极有效的预防措施,避免残胃癌的发生。

Surgical Treatment and Prevention of Gastric Stump Carcinoma

Objective To study early diagnosis, rational surgical treatment and prevention of gastric stump carcinoma. Methods Clinical data from 36 patients between Jan 1995 and Jan 2004 with gastric stump carcinoma receiving surgical therapy were retrospectively analyzed. The first gastric resection in these patients was Billroth II operation. The onset time of gastric stump carcinoma was 10 to 35 years after gastric resection. Results Among the 23 patients receiving radical resection, the one-year, three-year, and five-year cumulative survival rate was 78.26%, 34.80%, and 26.10%, respectively. 9 patients receiving palliative resection and 4 patients receiving no resection died within one year. Conclusion Early diagnosis is key to the success in the management of gastric stump carcinoma. Radical resection is the major strategy for surgical treatment of gastric stump carcinoma.