残胃癌诊治的研究进展与争议

Progress and controversy on diagnosis and treatment ofgastric stump cancer

残胃癌（GSC）是一类胃良、恶性疾病术后残胃出现癌变的疾病，常见于男性，发病风险具有明显的时间依赖性，随着初次手术间隔的延长，其发病率呈上升趋势。胃癌术后发生GSC的时间间隔显著短于良性疾病。GSC的主要致病因素包括十二指肠胃内容物的反流、胃黏膜的去神经化导致的胃内环境的改变和幽门螺杆菌（却）感染。胃切除术后由于GSC临床症状不典型，通常发现时病情已较晚，长期生存率低。因此，定期内镜筛查对于早期发现GSC具有重要意义。GSC的治疗与原发胃癌一样，包括病灶切除及根治性淋巴结清扫，R0切除是影响预后的重要因素。本文旨在通过综述国内外最新文献，以期对残胃癌的流行病学特点、病因、临床症状、治疗和预后等相关问题进行概述。

Gastric stump cancer （GSC） is a carcinoma arising from the remnant stomach following gastric surgery for benign or malignant disease, and is more common in men. The risk of morbidity has an obvious time dependence. GSC incidence is likely to rise with lengthening of the initial operation interval. The GSC time interval after malignant disease is significantly shorter than that of benign disease. GSC etiologies mainly include duodenogastric reflux and denervation of the gastric mucosa resulting in the change of the gastric environment after gastrectomy and theHelicobacter pylori infection. Due to atypical clinical symptoms, GSC is always identified at an advanced stage and the long-term survival rate is low. An optimal endoscopic surveillance system is essential to improve early detection rates. Treatments in GSC and primary gastric cancer are the same and include resection of the lesion and radical lymph node dissection. R0 resection is an important prognostic factor. Here we review previous reports with respect to epidemiological characteristics, etiology, clinical symptoms, treatment, and prognosis of GSC.