残胃癌的临床病理特征及预后分析

Clinicopathological characteristics and prognosis of remnant stomach cancer——report of 45 cases

目的探讨残胃癌的临床病理特征及预后相关因素。方法回顾性分析45例残胃癌患者的临床病理资料,并进行随访。结果45例残胃癌患者的男女比例为44∶1。初次手术距残胃癌的诊断时间为5～42年,平均23年。残胃病变位于吻合口28例,位于贲门9例,其余部位8例。未分化癌1例,低分化腺癌36例,中分化腺癌7例,高分化腺癌1例。根治性切除患者的1、3、5年生存率分别为100．0%、78．8%和47．2%,非根治性切除患者的1、3、5年生存率分别为62．5%、25．0%和0,两组患者生存率差异有统计学意义(P＜0．05)。10例病变未切除患者均于2年内死亡,平均生存时间为12个月。各病理分期患者间生存率差异有统计学意义(P＜0．05)。结论残胃癌多于BillrothⅡ式胃大部切除术后10年以上发生,男性多于女性,病变主要位于吻合口附近。进展期残胃癌病理类型以低分化腺癌常见。残胃癌的预后与病理分期、能否行根治性切除密切相关。

Objective To investigate the clinicopathological characteristics and prognostic factors of remnant stomach cancer. Methods The clinicopathological and prognosis data of 45 patients with remnant stomach cancer were retrospectively analyzed. Results The remnant stomach cancer are likely to develop in males with a ratio of male to female： 44： 1. Their initial operation modes of these patients were Billroth Ⅱ subtotal gastrectomy in 40 patients, Billroth Ⅰ subtotal gastrectomy in 4 and proximal subtotal gastrectomy in Ⅰ. The interval from the initial operation to the diagnosis of remnant stomach cancer was 5 to 42 years with an average of 23 years. Of these 45 patients, 28 had lesion at anastomotic site, 9 in the gastric cardia and 8 in other locations; 19 had radical resection, 16 palliative resection and 10 exploration alone except one who had an anastomosis of remnant stomach with the jejunum. The histology types included ： 1 un-differentiated adenocarcinoma, 36 poorly-differentiated adenocarcinoma, 7 moderately-differentiated adenocarcinoma and 1 well-differentiated adenocarcinoma. The 1-, 3-, 5-year survival rates of patients with radical resection were significantly better than those treated with palliative resection, which was 100% vs. 62.5% , 78. 8% vs. 25% , 47.2% vs. 0, respectively（ P 〈0.05 ）. All ten patients without resection died within 2 years with an average survival time of 12 months. The 5-year survival rate of stage Ⅰ , Ⅱ , Ⅲ and IV was 100% ,75%, 17.8% and 0, respectively （ P 〈 0.05 ）. Conclusion Remnant stomach cancer prevalently occurs in the male usually 10 years after Birroth Ⅱ gastrectomy. The lesions is mainly located at anastomotic site. Poorlydifferentiated adenocarcinoma is found to be the prevalent histological type of advanced remnant stomach cancer. The prognosis of remnant stomach cancer is correlated with pTNM stage and whether having been treated with complete resection or not. Patients with early remnant stomach cancer may survive for a long time if radical resection can be done.