残胃癌的临床病理学特征和预后

目的探讨残胃癌的临床病理学特征和外科治疗的效果及其预后。方法回顾性分析大连医科大学附属第一医院普通外科收治的42例残胃癌患者的临床资料。结果本组患者残胃癌发生部位以吻合口居多，组织学类型以低分化型癌为主。原手术方式为BillrothⅠ（BⅠ）式9例，BⅡ式33例。残胃癌的淋巴结转移，BⅠ式时No．1、No．3、No．10、No．11转移率大于30．0％，No．12转移率为22．2％；BⅡ式No．1、No．2、No．3、No．4及第2站的No．10、No．11、N0．12转移率均高于30．0％，No．14为25．0％。空肠系膜淋巴结转移率27．3％。BⅠ式患者胰腺浸润为66．7％．肝十二指肠韧带为33.3％；BⅡ式患者横结肠浸润为25．0％，胰腺浸润为75．0％。本组患者5年累计生存率为0．38：其中Ⅰ期0．86，Ⅱ期0．50，Ⅲ期0．13，Ⅳ期0，差异具有统计学意义（P〈0．05）。结论残胃癌的淋巴结转移和周围脏器浸润有其独特的方式和规律．外科手术是有效的治疗手段。

Clinicopathological features and outcome of patients with remnant gastric cancer

Objective To evaluate the clinicopathologic features and the efficacy of surgical treatment in gastric stump cancer. Methods Forty-two patients undergone operation for gastric stump cancer, including 9 cases with Billroth Ⅰ reconstruction and 33 cases with Billroth Ⅱ reconstruction, in our department were enrolled in the study. Clinieopathological features, 5-year survival rate and prognostic factors were analyzed retrospectively. Results Gastric stump cancer occurred more frequently in anastomotic site and poorly-differentiated cancer was the common histological type. For patients with Billroth Ⅰ reconstruction, the rates of lymph node metastasis in No.1, No.3, No.10, No.11 stations were more than 30.0%, and that in No.12 station was 22.2%. For patients with Billroth Ⅱ reconstruction, the rates of lymph node metastasis in No.1, No.2, No.3, No.4, No.10, No.11, No.12 stations were more than 30.0%, and that in No.14 station was 25.0%. The rate of lymph node metastasis in jejunal mesentery was 27.3%. The percentage of pancreatic invasion and hepatoduodenal ligament invasion were 66.7% and 33.3% respectively for patients with Billroth Ⅰ reconstruction. The percentage of transverse colon invasion and pancreatic invasion were 25.0% and 75.0% respectively for patients with Biliroth Ⅱ reconstruction. The overall 5-year survival rate of patients with gastric stump cancer was 0.38. The 5-year survival rates in Ⅰ, Ⅱ, Ⅲ and Ⅳ were 0.86, 0.50, 0.13 and 0 respectively. There were significant differences among stages (P<0.05). Conclusions Gastric stump cancer has a particular pattern in lymph node metastasis and direct organ invasion. Surgical resection is an effective therapeutic strategy for this disease.