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。

The clinicopathological features and prognosis of gastric stump carcinoma following curative surgery

Objective To evaluate the clinicopathological features and prognosis of gastric stump carcinoma (GSC) following curative surgery. Method The clinicopathological features and long-term survival rate of 63 pa-tients who had underwent curative gastrectomy for GSC from November 1999 to December 2014 were analyzed retro-spectively. Result Compared with malignant GSC, the benign ones following gastrectomy had a longer interval (24.8 years vs 8.9 years, P < 0.05), bigger tumor size (6.9 cm vs 4.3 cm, P < 0.05), and a higher proportion of GSC located in anastomosis (50% vs 26.3%, P < 0.05). As for Billroth Ⅱ vs Billroth Ⅰ, the Billroth Ⅱ reconstruction group had a longer interval (22.8 years vs 12.3 years, P < 0.05), bigger tumor size (6.73 cm vs 3.75 cm, P < 0.05), and a higher proportion of GSC located in anastomosis (52.4% vs 21%, P < 0.05). The 80-month survival rate of the stage Ⅲ group was significantly higher than that of the stage Ⅰ- Ⅱ group (64.7% vs 18.5%, P < 0.05). The 100-month survival rates of benign and malignant lesions following curative surgeries were similar (37.1% vs 40%, P >0.05), and the 80-month survival rates of Billroth Ⅱ and Billroth Ⅰ groups were also close (43.1% vs 27.3%, P >0.05). Conclusion The patients with GSC have different clinicopathological features as the initial diseases and the reconstruction methods vary. For patients with resectable GSC, long-term survival is associated with TNM staging, rather than the initial diseases and the reconstruction methods.