胃良性疾病患者行远端胃切除术后发生残胃癌和食管癌的危险因素分析

Risk factors for remnant gastric cancer and esophageal carcinoma for patients with benign gastric disease after distal gastrectomy

目的:探讨胃良性疾病患者行远端胃切除术后残胃癌和食管癌发生的相关危险因素。方法:回顾性分析2010年01月01日至2018年01月01日因胃良性疾病在我院行远端胃切除术的患者的病历资料,采用单因素分析和多因素logistic回归模型确定术后残胃癌和食管癌发生的独立危险因素,并建立远端胃切除术后食管癌、残胃癌发生风险的预测模型。结果:共纳入301例患者,残胃癌患者占11.96%,平均年龄(67.83±9.14)岁,其中进展期患者占83.33%,且只有55.56%的患者有手术机会,残胃癌多见于残胃体及吻合口。5.00%的患者发生了食管癌,平均年龄(68.00±8.73)岁,多见于食管下1/3段,均为进展期,且80.00%失去了手术机会。单因素和二元logistic回归分析显示,年龄≥65岁、手术间隔≥10年和胆汁反流是残胃癌的独立危险因素,年龄≥65岁和胆汁反流是食管癌的独立危险因素。将残胃癌和食管癌发生风险分为低危、中危、高危组,残胃癌在各组发生率分别为1.72%、8.62%、28.99%(P<0.001),食管癌分别为0.70%、4.88%、13.16%(P<0.001)。结论:年龄≥65岁、手术间隔≥10年的因胃良性疾病行远端胃切除术后的患者,建议密切进行胃镜随访。如发现胆汁反流,应仔细检查食管下1/3段、残胃体及吻合口。

Objective:To evaluate the risk factors associated with the incidence of remnant gastric cancer(RGC) and esophageal cancer(EC) for patients with benign gastric disease after distal gastrectomy(DG).Methods:From 1/1/2010 to 1/1/2018,we retrospectively analyzed the medical records of these patients,and established a prediction model for the risk of EC and RGC after DG.Results:There were 301 patients included,11.96% patients were observed with remnant gastric cancer with the mean age of(67.83±9.14) years old,among which 83.33% were advanced stages and only 55.56% patients had the chance for surgery.RGC were most commonly found in residual gastric body and anastomosis.5.00% patients were observed with EC with the mean age of(68.00±8.73) years old,and most commonly located at the lower third thoracic esophagus.All of them were advanced stages and 80.00% lost the chance of surgery.The univariate and binary logistic regression analysis demonstrated that age≥65 years,surgery interval≥10 years and bile reflux were the independent risk for remnant gastric cancer,and age≥65 years and bile reflux were independent risk for esophageal cancer.Then we stratified the incidence into low-risk,intermediate-risk,and high-risk groups,and it was 1.72%,8.62%,2 8.9 9 % for RGC respectively( P < 0.001) and 0.70%,4.88%,13.16% for EC respectively( P < 0.001).Conclusion:Patients with benign gastric disease after DG with age≥65 years and surgery interval≥10 years were recommended closely gastroscopic follow-up.If bile reflux is found,the lower third of esophagus,residual gastric body and anastomosis should be examined carefully.