复发性胃癌再手术指征及评价

Reoperation indication of recurrent gastric carcinoma and evaluation

目的探讨复发性胃癌的术后复发因素、再手术指征和手术效果评价。方法回顾性分析2010~2015年间的62例复发性胃癌再手术病例,分析其再手术指征、再手术方式和手术治疗效果。结果 62例患者中再手术切除35例（56.5%）;另27例为姑息手术病例（43.5%）,其中14例单纯行胃肠吻合,7例行空肠造口术,6例单纯探查。再手术后有3例患者发生吻合口出血（4.8%）,2例发生吻合口瘘（3.2%）,4例并发腹腔感染（6.5%）,并发症发生率为14.5%;死亡10例,死亡率为16.1%;其中再手术切除的35例中死亡2例（5.7%）,未切除的27例中死亡8例（29.6%）,两者死亡率差异具有统计学意义（x2=4.7976,P〈0.05）。结论复发性胃癌凡证实为吻合口或残胃复发,心肺功能尚可者,均宜再次手术切除,有利于提高生存率。

Objective To explore factors of postoperative recurrence, reoperation indication and evaluation of operative effect of recurrent gastric carcinoma. Methods 62 cases of reoperation of recurrent gastric carcinoma from 2010 to 2015 were retrospectively analyzed. Reoperation indication, ways of reoperation and curative effect of operation were analyzed. Results In 62 patients, there were 35 cases of re-resection accounting for 56.5% and 27 cases of palliative operation accounting for 43.5%. Of 27 cases, there were 14 cases of gastrointestinal anastomosis, 7 cases of jejunostomy and 6 cases of simple exploration. In reoperation, there were 3 cases of anastomotic bleeding accounting for 4.8%, 2 cases of anastomotic leakage accounting for 3.2%, 4 cases of complication with abdominal infection accounting for 6.5%. Incidence of complications was 14.5%. There were 10 cases of deaths and the death rate was 16.1%. In 35 cases of re-resection, there were 2 cases of deaths accounting for 5.7%. In 27 cases without resection, there were 8 cases of deaths accounting for 29.6%. Differences in death rates of patients with re-resection and patients without resection had statistical significance（x2=4.7976, P〈 0.05）. Conclusion Re-resection is suitable for patients with recurrent gastric carcinoma diagnosed as anastomosis or remnant stomach with good cardiopulmonary function, which is helpful to improve survival rate.