残胃癌的临床病理特征和预后

Clinicopathological characteristics and prognosis of gastric stump cancer

目的 探讨残胃癌的临床病理特征及预后的影响因素.方法 回顾性分析2000年1月至2006年12月期间收治的47例残胃癌的临床资料,分为良性病变组(39例)和恶性病变组(8例)手术后残胃癌进行分析,并对47例残胃癌预后进行生存分析.结果 残胃癌诊断距首次手术的间隔时间平均为24.4年,多发生于毕Ⅱ式胃大部切除术后,男性多于女性,好发于吻合口处,其次是胃体、贲门部,良性病变术后残胃癌比恶性病变术后残胃癌的间隔时间长(P＜0.05),病理类型、治疗及预后方面无明显差异(P＞0.05),TNM分期和根治手术对残胃癌的生存率有明显影响(P＜0.01).结论 现阶段恶性病变术后的残胃癌增多,与良性病变术后残胃癌在临床病理特点上没有明显不同,残胃癌的早期诊断和外科根治手术是预后的关键.

Objective To study the clinicopathologic characteristics and the prognostic factors of gastric stump cancer (GSC). Methods A total of forty-seven patients with GSC from Jan 2000 to Dec 2006 were enrolled in this study for retrospective analysis. Initial surgery was performed for gastric benign disease in 39 patients and for malignant disease in 8 patients, which were divided into 2 groups for analysis. The prognosis of all 47 patients were analyzed. Results The mean interval between previous gastrectomy and diagnosis of GSC was 24.4 years. Tumor developed mostly in the patients with Billroth- Ⅱ reconstruction, and male more than female. Tumor located at anastomotic site mostly, at stump stomach and cardia secondly. The mean interval for patients who had undergone their first gastrectomy for malignant disease was shorter than that with benign disease(P＜0.05). Histology, therapy and prognosis showed no significant differences between two groups (P＞0.05). Disease TNM stage and total radical gastrectomy were shown to be significant predictor for the outcome of patients with GSC (P ＜0.01). Conclusion Now the GSC patients with initial surgery performed for malignant disease are increased, which are no siginificant different to patients with benign disease. Early diagnosis and an aggressive surgical approach are crucial to achieve better outcomes for patients with GSC.