胃癌术后切端癌残留的原因分析及预防对策  

Cause and preventive measures of positive stump in gas-trectomy for gastric cancer

作　　者：荆晓岳[1] 李荣[2] 周兵[1] 李泽信[1] 王建国[1] 

机构地区：[1]新乡医学院第一附属医院普外科,河南卫辉453100 [2]新乡医学院护理学院,河南新乡453000

出　　处：《中国现代普通外科进展》2010年第3期196-198,共3页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:探讨胃癌切除术后切端癌残留的原因及预防对策。方法:回顾性分析1998年1月—2009年5月946例行胃癌切除术患者的临床资料,对癌残留情况进行统计学处理。结果:胃癌切除术后切端癌残留率为6.24%(59/946)。姑息性胃癌切除术癌残留率与根治性胃癌切除术癌残留率差异有统计学意义(18.87%vs5.49%,P<0.05);全胃切除较远、近端胃大部切除术切端癌残留率高(13.95%vs4.38%,6.50%,P<0.05);BorrmannⅢ～Ⅳ型、分化程度低及淋巴结转移数目在7个以上者切端癌残留率较高(P<0.05),而患者年龄、肿瘤直径和肿瘤浸润深度与切端癌残留率无关(P>0.05)。结论:姑息性切除、BorrmannⅢ～Ⅳ型、分化程度低及淋巴结转移数目在7个以上的胃癌易发生切端癌残留。重视术前胃镜及X线钡餐检查,结合术中探查情况决定切除范围,保证切缘距离,常规剖视标本,可疑时行术中冷冻检查是减少胃癌切除术切端癌残留率的有效措施。Objective： To investigate the cause and preventive measures of positive stump in gastrectomy for gastric cancer. Methods： Nine hundred forty-six patients performed with gastrectomy for gastric carcinoma had been collected from January 1998 to May 2009, the ratio of positive stump was analyzed retrospectively. Results： The rate of positive stump of gastrectomy was 6.24%（59/946）. Statistical difference was found between the rate of radical and palliative gastrectomy（P0.05）. There were also significant difference between total and partial gastrectomy. The inci-dence of residual cancer at the cut edge was closely related to gross type, degree of differentiation and numbers of metastatic lymph nodes （P0.05）. No statistical difference was found in age, tumor size and infiltrating depth（P0.05）. Conclusion： The rate of positive stump was higher in palliative gastrectomy, Borrmann Ⅲ～IV type, low differentiated cancer and those cases with metastatic lymph nodes more than seven. To prevent the occurrence of positive stump in gastrectomy for gastric cancer, gastroscopy and barium meal should be carried out, enough length between incisal margin and tumor edge should be kept and frozen biopsy should be done.

关 键 词：胃肿瘤 胃切除术 肿瘤 残余 

分 类 号：R735.2[医药卫生—肿瘤]