残胃癌的临床病理特征及治疗  

Clinical pathological features and treatment in gastric stump carcinoma

作　　者：王子卫[1] 韩文妙[1] 

机构地区：[1]重庆医科大学附属第一医院普外科,400016

出　　处：《腹部外科》2001年第5期267-269,共3页Journal of Abdominal Surgery

摘　　要：目的　探讨残胃癌的临床病理特征 ,以提高早期诊断率及根治性切除率。方法　回顾性分析我院近 5年来收治的 14例残胃癌。结果　残胃癌多见于男性 (13∶1) ;初次手术行BillrothⅡ式胃大部切除术 12例 ;初次手术距残胃癌的诊断时间平均为 15 .5年 ;临床表现主要有上腹饱胀、腹痛、吞咽困难、上消化道出血等。残胃病变有 7例在吻合口。11例施行手术 ,其中 2例行根治性残胃全切除术 ,7例行捷径手术及造瘘手术。病理检查有 8例为印戒细胞癌或低分化腺癌。结论　残胃癌多发生于初次胃部分切除术后 10年以上 ,多发生于BillrothⅡ式胃大部切除术后 ,病变主要位于吻合口附近 ,男性多于女性。当胃切除术后 10年以上 ,出现胃痛症状 ,上腹不适、饱胀、消瘦 ,或不明原因的贫血、上消化道出血 ,以及出现不明原因的呕吐等 ,应考虑到残胃癌的可能。争取早期诊断 ,早期施行根治性手术。Objective To study the clinical pathological features of gastric stump carcinoma for increasing early diagnostic rate and resection rate.Methods From 1995, 14 gastric stump carcinomas that were treated in our hospital were analyzed retrospectively.Results Males were more than females in the patients with gastric stump carcinoma (13∶1). Twelve patients were anastomosed with Billroth Ⅱ when they underwent subtotal gastrectomy first with the mean time being 15.5 years from first gastrectomy to gastric stump carcinoma diagnosed. Clinical symptoms included abdominal distension, abdominal pain, dysphagia, hemorrhage of superior digestive tract. Focus lay to anatomotic stoma in 7 patients. Eleven patients were treated surgically, 2 of the patients were operated on with total gastrectomy, and 7 of the patients underwent bypass operation or fistulation. Histological types of 8 gastric stump carcinomas were signet ring cell carcinomas or undifferentiated carcinomas.Conclusion Gastric stump carcinomas often rise ten years and over after subtotal gastrectomy with Billroth Ⅱ and males is common. The focus lies to gastric mucosa adjacent to anstomotic stoma. Therefore, when the patient undergoing subtotal gastrectomy 10 years and over have abdominal distension, abdominal pain, emaciation, hemorrhage of superior digestive tract, or unknown anemia and vomiting, they may be considered gastric stump carcinoma. It is very important to early diagnose and as far as possible have the curative resection.

关 键 词：残胃癌 诊断 治疗 临床病理 

分 类 号：R735.2[医药卫生—肿瘤]