残胃癌的临床病理特征及预后的荟萃分析

Clinicopathological characteristics and prognosis for gastric stump cancer, a meta-analysis

目的总结残胃癌的临床病理特征及手术治疗效果。方法对在青岛大学医学院附属医院已治疗过的及文献报道的共计902例残胃癌患者的年龄、性别、病理类型、TNM分期、手术治疗及预后等临床资料进行荟萃分析。结果本组残胃癌患者男女比例约为4．1：1，中位年龄61岁（35～80岁）。首次手术BillrothⅡ式重建术后残胃癌的发生率比Billroth Ⅰ式术后明显高（81．6％比17．1％）。癌灶好发于吻合口50．5％，其他如残胃小弯侧21．7％，贲门胃底18．5％，其余约占不到10％。残胃癌手术切除率和根治性切除率分别为81．3％和62．7％，其中有301例次（36．5％）行联合脏器切除术，根治性切除1、3、5年生存率分别为77．8％、58．2％、28．9％，姑息性切除1、3、5年生存率分别为36．4％、9．8％、3．9％，两组比较差异均有统计学意义（P〈0．01）。结论残胃癌多发生于BillrothⅡ式胃大部切除术后，病变主要位于吻合口，以分化型腺癌居多，就诊时以中晚期居多。联合脏器切除手术率高，早期发现，行根治性手术可提高生存率。

Objective To summarize the clinicopathological characteristics and effects of surgical treatment on gastric stump cancer. Methods With metaanalysis, clinical data of 902 gastric stump cancer patients who were treated in our hospital or were reported in literatures were included for analysis. Age, gender, pathological types, TNM stages, surgical treatment, prognosis were evaluated. Results Gastric stump cancer developed mostly in male patients（4. 1： 1 ）, and the median age was 61 years. Incidence of gastric stump cancer after digestive tract reconstruction with Billroth-Ⅱoperative modality was higher than that with Billroth- Ⅰ （81.6% vs. 17. 1% ）. 50. 5% of the cancers were present at the anastomotic site, 21.7% at the gastric lesser curvature, 18.5% at the gastric cardia, and less than 10% at other places. Resection and radical resection rates were 81.3% and 62. 7%, while operation combined organ resection was carried out （36. 5% ）. The 1-, 3-, 5- year survival rate of the patients with radical resection were significantly better than those with palliative resection, which was 77.8% vs. 36.4%, 58. 2% vs. 9. 8% and 28.9% vs. 3.9% （P 〈 0. 01 ） respectively. Conclusions Distal gastrectomy and Billroth Ⅱ GI tract reconstruction was the most common type of previous operation. Gastric stump cancer occurs more frequently at anastomotic site and the majority of histological types was well-differentiated adenocarcinoma. Most cases were at the advanced TNM-stage when diagnosed. Radical resection is an effective way to prolong the postoperative survival time in gastric stump cancer patients, especially in early stage.