残胃癌与残胃再发癌的临床病理特点

Clinical and pathological characteristics of gastric stump cancer and recurrent gastric stump cancer

目的 探讨残胃癌与残胃再发癌的早期诊断与合理外科治疗的方法。 方法 回顾性分析 2 0年收治的残胃癌 2 7例 ,残胃再发癌 2 3例的临床、病理资料。 结果 残胃癌多在胃切除术10年后发病 ,残胃再发癌多在 10年内发病 ;胃镜检查确诊优于双对比造影 ;发生在胃空肠吻合口的早期癌 ,可行部分残胃切除术 ,其它部位则应行全残胃切除术 ;吻合口癌空肠系膜淋巴结转移率约占40 % ,应常规清除此淋巴结 ;晚期病例外科治疗效果不佳。 结论 (1)胃癌切除术后近年、胃良性病切除术后 10年左右开始定期胃镜检查是发现残胃内癌的有效方法。 (2 )残胃再发癌比首次原发癌恶性程度更高。 (3)早期病例外科治疗效果较好 。

Objective[WT5”BZ] To study early diagnosis and rational treatment of gastric stump cancer and recurrent gastric stump cancer. [WT5”HZ] Methods[WT5”BZ] The data of 27 patients with gastric stump cancer and 23 patients with recurrent gastric stump cancer were analysed retrospectively during the past 20 years based on their clinical and pathological findings. [WT5”HZ]Results[WT5”BZ] The onset time was 10 years or more for gastric stump cancer and less than 10 years for recurrent gastric stump cancer after gastrectomy. Gastroscopy was better than double contrast radiography in diagnosis. Partial resection of gastric stump was performed for patients with early cancer at the anastomotic stoma of gastrojejunostomy. Total resection of gastric stump was made for other patients. Lymphonode of the mesojejunum were dissected routinely because their metastasis rate was about 40.0% in patients with cancer of anastomotic stoma. The effect of surgical treatment was poor for patients with advanced cancer. [WT5”HZ]Conclusions[WT5”BZ] Regular gastroscopy is useful in detecting gastric stump cancer in patients with gastric cancer after gastrectomy, or in those years after removal benign. Malignancy was more evident in recurrent gastric stump cancer than in primary gastric cancer. Prognosis is good for early stage cases and poor for late stage cases after surgical treatment. [WT5”HZ]