复发性胃癌的外科治疗

Surgical treatment for postoperative recurrence of gastric cancer.

目的 探讨胃癌手术后复发因素及其再手术的适应证。方法 回顾性分析 1974～ 1998年胃癌术后复发病人进行再次手术治疗 48例的临床资料 ,并对手术方法、术后并发症、病死率及术后病理结果进行了分析。结果 术后生存 5年以上 7例 ,3年以上 8例 ,2年以上 6例 ,1年以上 9例 ,1年内死亡者 12例。单纯探查者 6例分别于 3～ 6个月内死亡。结论 对胃癌术后复发者 ,再手术能否切除病灶主要取决于复发方式 ,凡证实吻合口或残胃复发者 ,即使侵及邻近脏器 ,无远处转移 ,且心肺功能可以耐受手术者 ,均应再次手术。

Objective To discuss the recurrent factors and the indications of second operation for gastric carcinoma postoperatively.Methods Retrospective analysis of 48 cases reoperated for recurrent gastric cancer between 1974 and 1998was done,and the operative methods,postoperative complications,mortality and pathologic results had been analysed.Results The survival periods were longer than 5 years in 7 cases,longer than 3 years in 8 cases,longer than 2 years in 6 cases,longer than 1 year in 9 cases and shorter than 1 year in 12 cases.The paitents who underwent laparotomy exploration all died within the period of 3 to 6 months.Conclusion Whether the lesion could be resected reoperatively or not depends upon the ways of recurrence in patients with recurrent gastric cancer.The second operation should be performed when anastomosis or remnant stomach recurrence is diagnosed even the surround organs are invaded,but no farther metastasis and the patients have good cardiopnenumatic function and can tolerate the operation.