胃大部切除术后残胃癌51例临床诊疗分析  

Clinical Analysis of 51 Cases of Gastric Stump Cancer after Subtotal Gastrectomy

作　　者：顾钧[1] 沈定丰[1] 全志伟[1] 

机构地区：[1]上海交通大学医学院新华医院普外科,上海200092

出　　处：《中国现代手术学杂志》2008年第6期416-419,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的研究胃大部切除术后发生残胃癌(gastric stump cancer,GSC)的相关因素及治疗结果。方法回顾性分析462例接受胃大部切除术患者的临床资料,共发生GSC51例,残胃癌发病距胃大部切除术平均时间为15年。34例行手术治疗,其中24例行根治手术,10例行姑息性切除;未能切除的17例中,行姑息性胃空肠吻合6例,空肠造瘘4例,活检术2例,未手术5例。结果围手术期无死亡病例,根治性切除和姑息性切除的中位生存期分别为32.7个月和13.2个月。未行手术切除的17例GSC患者,于发病后3～11个月内死亡。51例GSC患者中,原溃疡位于胃部者占23.1%(40/173),十二指肠球部占3.8%(11/289),两者有显著差异(P<0.05);采用BillrothⅡ式和BillrothI式胃大部切除术患者的术后GSC发生率分别为12.8%(41/321)和7.1%(10/145),两者比较有显著差异(P<0.05)。结论外科手术在GSC的治疗中具有积极的意义。GSC多发生于BillrothⅡ式胃大部切除术后且原发溃疡位于胃部的患者,术后10年以上者发生癌变的危险性较大。Objective To study the treatment and outcomes of gastric stump cancer （GSC） after subtotal gastrectomy, and to analyze the possible related factors for the development of GSC. Methods The clinical data of 462 patients with subtotal gastrectomy were retrospectively analyzed. There were 51 patients developed GSC in 15 years averagely after subtotal gastrectomy, in whom 34 had the GSC resected including 24 received radical operations, and 10 received palliative operations. In the other 17 cases who had the GSC remained, 6 received palliative gastrojejunostomy, 4 of jejunal stoma, 2 of biopsy, and 5 without operation. Results There was no death during the perioperative period, and the median survival time was 32.7 and 13.2 months in the radical and palliative surgery patients respectively. Those 17 without tumor resected died 3 to 11 months after the development of GSC. Among the 51 cases with GSC, stomach was found as the original site of ulcer in 40（23.1% ） , and duodenal bulb in the other 11 （3.8%） （P 〈0.05）. The incidence rate of GSC in the Billroth 11 subtotal gastrectomy and the Billroth I subtotal gastreetomy was 12.8% and 7.1% （ P 〈 0. 05 ）. Conclusions Surgical management plays a positive role in the treatment of GSC. The patients who receive Billroth II subtotal gastreetomy for the original stomach ulcer are more susceptible to GSC, especially in more than 10 years after the subtotal gastrectomy.

关 键 词：胃切除术 胃肿瘤 胃溃疡 十二指肠溃疡 

分 类 号：R735.2[医药卫生—肿瘤]