远端胃切除术后的残胃癌临床病理特征

Clinicopathological features of patients with gastric stump carcinoma after a distal gastrectomy

目的探讨残胃癌的临床病理学特征和外科治疗的效果。方法回顾性分析1993-2003年大连医科大学附属第一医院外科收治并获得随访的89例残胃癌(初次手术良性病变组42例,初次手术恶性病变组47例)的临床病理学特征、术后5年存活率和影响预后的因素。结果残胃癌发生部位以吻合口居多,组织学类型以低分化型癌为主。残胃癌的淋巴结转移,No.1、2、3、4、10、11、12淋巴结转移率为30.5%～61.0%,No.14淋巴结为25%。空肠系膜淋巴结转移率为27.3%～50.4%。残胃癌中的Billroth-Ⅰ式重建的No.10、11、12具有高频度的淋巴结转移率,Billroth-Ⅱ式中的空肠系膜淋巴结转移率高达50.4%。残胃癌的周围脏器的直接浸润在Billroth-Ⅰ式胰腺浸润为66.7%,肝十二指肠韧带为33.3%;在Billroth-Ⅱ式病例横结肠浸润为25.0%～28.5%,胰腺浸润为71.4%～75.0%。初次手术良性组的残胃癌5年累积存活率为38.1%,恶性病变组为10.4%。根治度A、B病例的累积5年存活率,初次手术良性病变组为53.6%,恶性病变组为22.2%(P<0.05)。结论残胃癌的淋巴结转移和周围脏器浸润有其独特的方式和规律,外科手术是有效的治疗手段。

Objective To discuss the clinicopathologic feature and the effect of surgical treatment in gastric stump carcinoma （GSC）. Methods Eighty-nine patients who undergone operation for GSC （42 patients with primary diseases were benign, 47 patients with primary diseases were malignant） between 1993 and 2003 in the Department of General Surgery of the First Affiliated Hospital of Dalian Medical University were studied. Clinicopathologic feature, the 5-year survival rate after operation and prognostic factors were analyzed retrospectively. Resets GSC occurs more frequently in anastomotic site and the majority of histological types was poorly-differentiated cancer. In metastasis of lymph node of GSC, the rate of lymph node metastasis in No.t,2,3,4,10,11,12 stations was 30.5%-61.0%, and that in No.14 station was 25%. The percentage of lymph node metastasis in jejunal mesentery was 27.3% - 50.4%. Patients performed Billroth - Ⅰ reconstruction were found high rate of lymph node metastasis in No. 10,11,12 stations. Patients performed Billroth- Ⅱ reconstruction showed that the rate of lymph node metastasis in jejunal mesentery was up to 50.4%. In the organ invasion of GSC , the percentage of pancreatic invasion and hepatoduodenal ligament invasion was 66.7% and 33.3%, respectively, for patients with Billroth-Ⅰ reconstruction. The percentage of transverse colon invasion and pancreatic invasion was 25.0% - 28.5% and 71.4% - 75.0%, respectively, for patients with Billroth- Ⅱ reconstruction. The overall 5- year sirvova; rate for patients with GSC secondary to benign diseases was 38.1%, that in patients with GSC secondary to malignant diseases was 10.4%. The overall 5-year survival rate for radical A and B in GSC secondary to benign diseases and malignant diseases was 53.6% and 22.2% respectively with statistically significant difference （P〈 0.05）. Conclusion GSC has a particular pattern in lymph node metastasis and direct organs invasion. Surgical resection is considered an effective therapeutic strategy for GSC.