48例残胃癌的临床病理特征及预后研究

Clinicopathologic Features and Prognosis of 48 Cases with Gastric Stump Cancer

目的探讨残胃癌的临床病理特征及影响预后的相关因素。方法回顾性分析2007年7月—2012年6月西南医科大学附属医院胃肠外科收治的48例残胃癌患者的临床资料。结果收集有效残胃癌患者病历资料48例,包括初发疾病为良性(21例,43.8%)和恶性(27例,56.2%);初次消化道重建方式包括BillrothⅠ式(11例,22.9%)、BillrothⅡ式(31例,64.6%)、Roux-en-Y(6例,12.5%)。48例患者均行手术治疗,包括根治性切除(43例,89.6%)、姑息性切除(5例,10.4%)。组织学类型分为分化型(20例,41.7%)和未分化型(28例,58.3%)。术后病理分期Ⅰ期(3例,6.2%)、Ⅱ期(8例,16.7%)、Ⅲ期(30例,62.5%)、Ⅳ期(7例,14.6%),1年、3年、5年总生存率分别为87.5%、52.1%、18.8%。初发疾病的性质与两次手术时间间隔及初次消化道重建方式差异有统计学意义(P<0.05)。Cox比例风险模型显示手术切除方式、组织学类型、TNM分期是患者预后的独立影响因素(P<0.05)。结论初发疾病的良恶性影响残胃癌的发病时间,而与年龄、性别、症状、肿瘤位置、Borrmann分型、组织学类型、肿瘤浸润深度、淋巴结转移、远处转移、TNM分期及其预后无明显联系,根治性手术切除是目前提高患者生存时间最重要的治疗方式。

Objective To explore the clinicopathologic features and related influencing factors on prognosis of gastric stump cancer（ GSC）.Methods A retrospective analysis was made to the clinical data of 48 cases with GSC hospitalized during the period from July,2007 to June,2012 in Department of Gastrointestinal Surgery of the Affiliated Hospital to Southwest Medical University.Results Effective data of 48 cases with GSC were collected,including 21 cases with benign primary diseases（ 43. 8%） and 27 cases with malignant primary diseases（ 56. 2%）; Billroth Ⅰ was adopted for initial digestive tract reconstruction in 11 cases（ 22. 9%）,Billroth Ⅱ in 31 cases（ 64. 6%） and Roux-en-Y in 6 cases（ 12. 5%）; all the 48 cases received surgical treatment,including radical resection in 43 cases（ 89. 6%） and palliative resection in 6 cases（ 12. 5%）; the histologic types included differentiation（ 20 cases,41. 7%） and undifferentiation（ 28 cases,58. 3%）; postoperative pathological stage Ⅰ was found in 3 cases（ 6. 2%）,stage Ⅱ in 8 cases（ 16. 7%）,stage Ⅲ in 30 cases（ 62. 5%） and stage Ⅳ in 7 cases（ 14. 6%）; the overall survival rate of 1,3 and 5 years was 87. 5%,52. 1% and 18. 8% respectively; there existed statistical differences between the nature of primary diseases and the time interval of the 2 operations,and among the initial gastrointestinal reconstructions（ P〈0. 05）;Cox proportional hazard model indicated that the operation styles,histologic types and TNM stages were the independent influencing factors on prognosis.Conclusions The nature of primary disease,benign or malignant,is of certain influence on the onset time of GSC while is of no obvious relation with age,gender,symptoms,location of the tumor,Borrmann type,histological type,depth of tumor invasion,lymph node metastasis,distant metastasis,TNM stage and prognosis; radical resection is the most effective treatment,up to now,in prolonging the survival time of the cases with GSC.