残胃癌的临床病理特点和诊治  

Clinicopathological features and diagnosis and surgical treatment of gastric stump cancer

作　　者：程应东[1] 杨桦[1] 罗云生[1] 

机构地区：[1]第三军医大学新桥医院普通外科,重庆400037

出　　处：《重庆医学》2009年第5期526-528,共3页Chongqing medicine

摘　　要：目的探讨残胃癌临床特点及合理的外科治疗方法。方法回顾性总结本院收治的19例残胃癌患者的临床资料，分析残胃癌临床表现特点及治疗与转归。结果残胃癌平均潜伏期24．3年。全组19例患者均接受了剖腹探查，手术切除9例（47．4％）。根治性切除7例（36．8％），包括残胃全切除3例，行联合器官切除术4例：残胃加左半肝切除1例，残胃加横结肠切除1例，残胃加脾切除1倒，残胃加脾、胰尾切除1例；姑息性残胃切除、残胃空肠吻合2例，空肠造瘘5例；4例剖腹探查加置化疗泵；1例诊断性探查与活检。消化道重建术式均为Roux—en-Y吻合术。本组无住院死亡病例。14例患者获得随访，1、3、5年生存率分别为64．3％、42．9％、21．4％；7例根治性切除患者1、3、5年生存率分别为100％、85．7％、42．9％。姑息性切除患者生存时间平均为20（15～25）个月。残胃病灶未切除者生存时间平均为6．8（3～11）个月。结论胃大部分切除术后要定期进行内镜检查，可早期发现残胃癌，及时行残胃癌根治术或联合脏器切除术，可改善患者生活质量和延长患者生存期。To evaluate the clinicopathological features and surgical outcomes of gastric stump cancer （GSC）. Methods We reviewed the medical records of 19 patients who underwent laparotomy for GSC at Xinqiao Hospital of Third Military Medical University between January 1988 and December 2007. Results The mean interval between the first and second operations was 24.3 years. In this study,all of the 19 GSC patients underwent surgery. The resection rate was 47. 4% （9/19） and the curative resection rate was 36.8% （7/19） in the patients with GSC. In 4 patients, the resection of adjacent organs （liver, 1; pancreas, 1; colon, 1; spleen, 1） was necessary for complete removal of tumor. Feeding j ejunostomy was performed in five patients with unresectable tumors. In one patient with peritoneal metastasis received diagnostic laparotomy. There was no mortality in the hospital period. Fourteen patients had followed up. The overall 1-year,3-year and 5-year survival for the 14 GSC patients was 64.3% ,42. 9% and 21.4% respeetively;the 1-year,3-year and 5-year survival for the GSC patients who underwent curative resection was 100%, 85.7% and 42.9% respectively. Conclusion The patients with previous partial gastric resections have to be strictly followed up in order to detect a possible cancer in early stages. Once GSC is detected, curative resection has to be the goal of surgical management. Consequently, this will give rise to better surgical results and survival.

关 键 词：肿瘤 残胃 生存 临床特点 外科治疗 

分 类 号：R735.2[医药卫生—肿瘤] R730.56[医药卫生—临床医学]