残胃癌的临床特点及治疗探讨

目的探讨残胃癌的临床特点及手术治疗效果。方法对巢湖市第二人民医院普外二科2000～2011年收治的18例残胃癌患者临床资料加以总结分析。结果本组病例男性15例,女性3例,年龄38～79岁,首次手术胃肠重建方式BilrothⅡ式14例(78%),BilrothⅠ式3例(17%),胃空肠Roux-en-y吻合1例(0.5%)。癌灶发生于吻合口附近10例(55.5%),残胃小弯侧6例(30.3%),胃底贲门部位2例(14.2%)。18例中行根治性残胃切除8例(44.4%),姑息性残胃切除6例(30.3%),联合脏器切除5例(27.8%),剖腹探查+空肠造瘘4例(22.2%)。根治性切除组1、3、5年生存期分别为87.5%,50%,12.5%。姑息性切除组中位生存期平均为15个月,剖腹探查组均在1年内死亡。结论残胃癌多发生在残胃吻合口附近,以BilrothⅡ式胃大部切除术后常见,男性多于女性,就诊时多属于中晚期,联合脏器切除率高,根治性手术可提高生存率。

Clinical features and treatment for gastric stump cancer

Objective To investigate the clinical features and surgical treatment of gastric stump cancer.Methods The clinical data of 18 cases gastric stump cancer patients treated in the second department of general surgery of Chaohu City Second People’s Hospital from 2000 to 2011 were analyzed.Results For this group of patients aged 38-79 years old,including 15 males and 3 females,there were 14 cases(78%) whose first operation of the gastrointestinal reconstruction way was Bilroth Ⅱ type,3 cases(17%) were of Bilroth Ⅰtype,and 1 case(0.5%) had stomach and jejunum Roux-en-y anastomosis.There were foci occurrence near the anastomotic stoma in 10 cases(55.5%),lesser curvature of remnant stomach in six cases(30.3%),and fundus of stomach cardia in 2 cases(14.2%).Of 18 cases,gastric remnant radical resection was performed in 8 cases(44.4%),palliative gastric remnant resection in 6 cases(30.3%),combined organ resection in 5 cases(27.8%),and exploratory laparotomy combined with jejunal fistula in 4 cases(22.2%).1,3,5-year survival in radical resection group was 87.5%,50%,and 12.5%,respectively.In palliative resection group,the median survival time was 15 months,and all patients in laparotomy group died within a year.Conclusion Gastric stump cancer occurs in the vicinity of the residual stomach anastomotic stoma,common after Bilroth II gastrectomy resection.There are more men than women,mostly in medium and advanced cancer for treatment and with high rate of visceral resection.Radical surgery may improve the survival.