1195例胃大部切除术后残胃病变临床与内镜检查分析

目的通过分析胃大部切除术后残胃病变的临床特点及内镜表现，探讨不同手术方式对病变的影响。方法将本院1984年4月至2008年10月检出的1195例残胃患者按毕Ⅰ式和毕Ⅱ式进行分组，对其临床症状、内镜表现、病理结果及随访情况进行回顾性分析。结果胃大部切除术后残胃病变发生率高达98．08％，毕Ⅱ式术后残胃及吻合口炎（90．77％）、胆汁反流（71．59％）、残胃原发癌（4．55％）的发生率均显著高于毕Ⅰ式（51．15％、34．48％、1．72％），P〈0．01，残胃及吻合口溃疡发生率则是毕Ⅰ式（28．45％）明显高于毕Ⅱ式（16．73％），P〈0．01，其余残胃病变两组比较差异无统计学意义（P〉0．05）。结论胃大部切除术是治疗胃恶性肿瘤、消化性溃疡及其严重并发症的主要方法，毕Ⅱ式较毕Ⅰ式术后更易发生并发症；近年来，残胃病变发病率有下降趋势；定期复查内镜及病理是防治残胃病变尤其是残胃癌的重要措施。

Clinical gastric stump lesion by analyzing the clinical characteristics and endoscopic features of remnant stomach after subtotal gastrectomy

Objective To investigate the influence of different operation methods on the gastric stump lesion by analyzing the clinical characteristics and endoscopic features of remnant stomach after subtotal gastreetomy. Methods 1195 cases of patients with remnant stomach in our hospital, who were detected between 1984 and 2008, were grouped by Billroth Ⅰ and Billroth Ⅱ , and were retrospectively analyzed from the aspects of clinical symptoms, endoscopic manifestations, pathology results and follow - up status. Results The incidenc of gastric stump lesion was as high as 98.08%. The incidences of gastritis of the remnant stomach and anastomotie, bile reflux, cancer of the remnant stomach and anastomotie were 90. 77%, 71.59% and 4.55% in patients with Billroth Ⅱ , and were apparently higher than Billroth Ⅰ （51.15% , 34.48% , 1.72% ） , P 〈 0. 05. The incidence of ulcer of the remnant stomach and anastomotic was 28.45% in patients with Billroth Ⅰ , and was 16. 73% in patients with Billroth Ⅱ, P 〈0. 01. There were no significant differences found between the other gastric stump lesion of Billroth Ⅰ and Billroth Ⅱ , P 〉 0. 05. Conclusions The subtotal gastrectomy was the main treatment methods of gastric malignant tumor, peptic ulcer and severe complications. The complications were more in patients with Billroth Ⅱ than Billroth Ⅰ . Periodical reexamination for the patients who underwent partial gastrectomy by endoscopy with multiple biopsies is the important measure for detecting gastric stump lesion, and especially for gastric stump cancer.