残胃癌的临床诊断和外科治疗

目的：总结残胃癌的临床诊断和改进残胃癌的外科治疗效果。方法：回顾性分析我科1995年1月-2005年12月间收治的36例残胃癌的发病情况、临床表现及治疗结果。结果：首次胃切除病因以消化性溃疡为主（35例,占97.2%）,首次手术B-Ⅱ式29例,占80.6%。确诊残胃癌距首次胃切除手术时间平均为17.5年。残胃癌发生于胃肠吻合口者占58.0%,发生于残胃小弯者占35.9%,发生于贲门者占6.1%,根治性切除手术占58.3%（21例）。结论：良性胃十二指肠病变行胃切除手术治疗时应以B-Ⅰ式或Roux-en-Y吻合为首选,B-Ⅱ式吻合需加Braun吻合较为合理。对残胃癌高危人群应定期行胃镜检查,早期诊断、早期根治性手术切除是提高残胃癌预后的关键。

Clinical diagnosis and surgical treatment of gastric stump carcinoma

Objective：To summarize clinical diagnosis and improve surgical therapeutic effect of gastric stump carcinoma（GSC）.Methods： Thirty-six cases of gastric stump carcinoma（GSC） patients receiving surgical treatment were reviewed respectively with regarding to morbidity,clinical manifestation and therapeutic outcome retrospectively.Results： Out of 36 patients 35（97.2%） underwent the first subtotal gastrectop my for petic ulcer,and 29 cases（80.6%） received Billroth-Ⅱoperation.The mean time from the first operation to the diagnosis of gastric stump carcinoma were 17.5 years.58.0% of the gastrac stump carcinoma occurred at anastomotic stomas,35.9% at residual lesser curvature and 6.1% at cardia.Radical reopration occupied 58.3%（21/36）.Conclusion： Billroth-Ⅰor Roux-en-Y should be the first choice for benign gastric lesions.If using Billroth-Ⅱanastomotic procedure should be added with Braun＇s anastomosis.Regular gastroscopic screening in highly risk populations,early diagnosis and early positive radical re-operation are of critical importance for improving prognosis of gastric stump carcinoma.