30例残胃癌临床病理特征分析及治疗

Clinical analysis and therapy of 30 cases of gastric stump cancer after subtotal gastrectomy

目的探讨残胃癌的临床特点、病理特征及诊治方法。方法回顾性分析安徽医科大学第一附属医院2001～2008年间普外科收治的30例残胃癌患者的临床资料及治疗情况。结果 30例残胃癌患者男性29例(96.7%),首次手术行B illrothⅡ式24例(80%)。病变位于原吻合口10例(33.3%)。术后病理低分化腺癌14例(46.7%),印戒细胞癌3例(10%),粘液细胞癌2例(6.7%),低分化腺癌合并粘液腺癌1例(3.3%)。27例残胃癌患者行手术治疗,其中根治性手术22例(76.7%),姑息性手术5例(16.7%),两种术式中位生存期分别是2.5年和1.6年。结论残胃癌好发于男性,以首次手术行B illrothⅡ式多发。胃大部切除术后应定期行胃镜等相关检查。由于病理恶性程度较高,一旦确诊,应尽早行根治性残胃切除,晚期患者无法行根治性手术的也应该积极争取行姑息性手术,能有效提高患者的生存时间和生活质量。

Aim To review the clinical symptom,the pathological characteristics,as well as the procedure of diagnosis and treatment for gastric stump cancer.Methods 30 cases of gastric remnant carcinoma admitted by The First Affiliated Hospital of Anhui Medical University from 2001 to 2008 were studied retrospectively.Results There were 29 males,24 patients operated with Billroth II.A total of 10 lesions were located at the stomas.Histological types of 14 gastric stump carcinomas were signet-ring cell carcinomas,3 undifferentiated carcinomas,and 2 mucoid carcinomas.Radical resections were performed in 22 cases,and 5 received palliative resections.The median survival time for these two approaches were 2.5 and 1.5 years respectively.The rest 3 cases receiving conservative treatment all died in 1 year after the diagnosis of GSC.Conclusion Gastric stump cancer often develop after Subtotal Gastrectomy with Billroth II and is common in males.It is necessary to carry out the periodic endoscopic examination in the patients who have received gastrectomy.Radical resection is the major strategy for surgical treatment of gastric stump cancer,for those who does not have the indication for a radical resection,palliative operation is strongly suggested,for it may effectively raise patient＇s survival time and life quality.