残胃癌的临床特征及预后分析

Analysis of endoscopic,clinical characteristics and prognosis of gastric remnant cancer

目的探讨残胃癌(GRC)胃镜所见、临床特征及预后影响因素。方法收集广东省台山市人民医院和中山大学附属第二医院1990年1月至2006年10月经胃镜及病理确诊为GRC的患者102例,分析其发生率、性别、年龄、临床表现、病程、手术病因、术式、幽门螺杆菌(Hp)感染率、残胃癌变部位、病理类型等特点及影响预后因素。结果本组患者GRC发生率为4.78%,男性患者明显多于女性,病程超过10年者占96.1%,平均病程为16.67年。胃溃疡术后致癌率(5.30%)与十二指肠球部溃疡术后致癌率(5.05%)相仿。行毕Ⅱ式患者GRC发生率(3.28%)明显高于行毕Ⅰ式者(1.50%)。GRC的Hp感染率(66.67%)明显高于同期一般残胃人群(29.68%)。GRC临床表现不典型,癌变部位多发生于吻合口,组织学分化较差,恶性程度高。根治性切除组1、3、5年生存率分别为100%、65.2%、33.8%;非根治切除组的1、3、5年生存率分别为26.3%、11.4%和0。结论残胃患者中,病程超过10年、行毕Ⅱ术式、Hp感染等均为GRC的高危因素;胃镜结合病理活检是目前确诊GRC的主要方法;残胃癌的预后与病理分期和能否行根治性切除密切相关。

Objective To study the clinical pathological characteristics and endoscopic features of gastric remnant cancer（GRC）as well as the factors influencing prognosis of gastric remnant cancer.Methods The data of patients with GRC between 1990 ～ 2006 were collected.According to the clinical data and the endoscopic diagnostic criteria with multiple biopsies,102 patients were enrolled.The data of the positive detection rate,gender,age,clinical manifestations,course of disease,pathology,surgical modality,Helicobacter pylori（H.pylori）infection,site of lesion,endoscopic features and survival rate of the patients were analyzed.Results The detection rate of GRC was 4.78%,males was more than females with main occurrence in elderly patients（70.59%）.The course of disease more than 10 years reached 96.1% with a mean interval of 16.6 years.The incidences of GRC after operation for gastric ulcer and duodenal ulcer were similar（5.30% vs.5.05%,P 〉 0.05）.The incidence of GRC after Billroth Ⅱ was higher than that of Billroth Ⅰ（3.28% % vs.1.50%,P 〈 0.05）.The positive rate of GRC in patients with H.pylori infection was higher than that of gastric renmnant patients without cancer in the same period（66.67% vs.29.68% P 〈 0.01）.The clinical features of GRC were nonspecific;the site of GRC lesion was most commonly located in the anastomotic region.One-year,3-year and 5-year survival rates of the patients with radical resection were significantly higher than those with palliative resection（100% vs.26.3%,65.2% vs.11.4%,33.8% vs.0,respectively,P 〈 0.05）.Conclusions Among the patients with gastric remnant cancer,more than 10 years of history,Billroth Ⅱ operation and H.pylori infection are the high risk factors for GRC,and endoscopy with biopsy is currently the main method for the diagnosis.The prognosis of GRC is correlated closely with the pathological stage and the probability of the radical resection.