可根治切除残胃癌的临床病理特征及预后

The clinicopathological features and prognosis of gastric stump carcinoma following curative surgery

目的：分析可根治切除残胃癌临床病理特征及预后情况。方法回顾性分析1999年11月至2013年12月进行残胃癌根治切除术的63例患者的临床病理资料，按照初次手术方式和初次手术时疾病良恶性分组，分析比较残胃癌的临床病理特征及患者的长期生存率。结果按照初次手术疾病良恶性分组，残胃癌发病的间隔时间分别为24.8年和8.9年；肿瘤直径分别为6.9 cm和4.3 cm ，残胃癌位于吻合口的比例分别为50%和26.3%。按照初次手术方式（BillrothⅡ、BillrothⅠ）分组，残胃癌发病的间隔时间分别为22.8年和12.3年。肿瘤直径分别为6.73 cm和3.75 cm ，残胃癌位于吻合口的比例分别为52.4%和21%。以上各组进行比较，差异均具有统计学意义（均P＜0.05）。TNMⅠ～Ⅱ期与Ⅲ期患者80个月生存率分别为64.7%和18.5%，差异有统计学意义（P＜0.05）。初次手术良性组与初次手术恶性组，100个月累积生存率分别为37.1%和40%，差异无统计学意义（P＞0.05）。BillrothⅡ组与BillrothⅠ组，患者80个月累积生存率分别为43.1%和27.3%，差异无统计学意义（P＞0.05）。结论初次胃切除术时疾病良恶性、重建方式与残胃癌发病间隔时间、肿瘤大小、肿瘤好发部位等临床特点有关。可根治切除的残胃癌患者，其长期生存率与初次胃切除术时疾病良恶性、重建方式无关，与TNM分期有关。

Objective To evaluate the clinicopathological features and prognosis of gastric stump carcinoma （GSC） following curative surgery. Method The clinicopathological features and long-term survival rate of 63 pa-tients who had underwent curative gastrectomy for GSC from November 1999 to December 2014 were analyzed retro-spectively. Result Compared with malignant GSC, the benign ones following gastrectomy had a longer interval （24.8 years vs 8.9 years, P 〈 0.05）, bigger tumor size （6.9 cm vs 4.3 cm, P 〈 0.05）, and a higher proportion of GSC located in anastomosis （50% vs 26.3%, P 〈 0.05）. As for Billroth Ⅱ vs Billroth Ⅰ, the Billroth Ⅱ reconstruction group had a longer interval （22.8 years vs 12.3 years, P 〈 0.05）, bigger tumor size （6.73 cm vs 3.75 cm, P 〈 0.05）, and a higher proportion of GSC located in anastomosis （52.4% vs 21%, P 〈 0.05）. The 80-month survival rate of the stage Ⅲ group was significantly higher than that of the stage Ⅰ- Ⅱ group （64.7% vs 18.5%, P 〈 0.05）. The 100-month survival rates of benign and malignant lesions following curative surgeries were similar （37.1% vs 40%, P 〉0.05）, and the 80-month survival rates of Billroth Ⅱ and Billroth Ⅰ groups were also close （43.1% vs 27.3%, P 〉0.05）. Conclusion The patients with GSC have different clinicopathological features as the initial diseases and the reconstruction methods vary. For patients with resectable GSC, long-term survival is associated with TNM staging, rather than the initial diseases and the reconstruction methods.