残胃癌再次手术根治性的相关因素  

Risk factors for radical reoperation in patients with remnant gastric cancer

作　　者：陈长义 余培东 

机构地区：[1]宁夏回族自治区固原市医院普外科,宁夏回族自治区固原市756000 [2]宁夏回族自治区固原市医院肿瘤外科,宁夏回族自治区固原市756000

出　　处：《世界华人消化杂志》2015年第28期4563-4567,共5页World Chinese Journal of Digestology

摘　　要：目的:探究残胃癌再次手术根治性的相关因素,以期能为后期临床治疗提供参考依据.方法:回顾性分析2009-01/2015-01宁夏回族自治区固原市医院普外科收治的因残胃再发癌接受二次手术的60例患者的临床资料.对残胃癌再次手术根治性的相关因素进行探究.结果:60例患者中有26(43.33%)例患者采用根治性残胃切除手术,16(26.67%)例患者采用姑息性残胃切除手术,15(25.00%)例患者采用空肠造瘘和短路术,3(5.00%)例患者无法进行手术.单因素分析结果显示,患者的年龄、消化系重建方式、初次手术TNM分期、初次手术N分期、淋巴结清扫范围、复发时有无症状、复发与二次手术间隔时间、复发时间、术后辅助化疗、幽门螺杆菌(Helicobacter pylori,H.pylori)感染、低胃酸、组织学分化均与患者的二次手术根治性有一定的相关性(P<0.05).多因素Logistic回归分析结果显示,患者的年龄>60岁、初次手术N分期、初次手术TNM分期、复发时有症状、H.pylori感染、组织学类型和低胃酸为残胃癌再次手术患者根治性的独立危险因素(P<0.05).结论:年龄>60岁、初次手术时TMN分期为Ⅲ期、初次手术时N分期为N0期、复发时有症状、发生H.pylori感染、低胃酸且组织学类型为腺癌的患者二次手术的根治率较低.AIM：To identify the risk factors for radical reoperation in patients with remnant gastric cancer.METHODS：A retrospective analysis was performed of clinical data for 60 patients with recurrent gastric stump cancer who underwent a second surgery from January 2009 to January2015 at Ningxia Guyuan Hospital.Risk factors for radical reoperation were identified.RESULTS：Of 60 patients,26（43.33%） were treated by radical surgery,16（26.67%） were treated by palliative surgery,15（25.00%） by gastric bypass surgery and jejunostomy,and 3（5.00%） did not underwent surgery.Univariate analysis showed that age,gastrointestinal reconstruction,TNM stage at initial surgery,N stage at initial surgery,lymph node dissection,symptomatic recurrence,interval between recurrence and the second surgery,time to recurrence,adjuvant chemotherapy,Helicobacter pylori（H.pylori） infection,low stomach acid,and histology were significantly associated with a second radical surgery（P〈0.05）.Multivariate Logistic regression analysis showed that age 60 years,N stage at initial surgery,TNM stage at initial surgery,symptomatic relapse,H.pylori infection,histological type and low stomach acid were independent risk factors for a second radical surgery（P〈0.05）.CONCLUSION：Age60 years,TMN stage Ⅲat initial surgery,NO stage at initial surgery,symptomatic relapse,H.pylori infection,low acid and histological type are independent risk factors for a second radical surgery in patients with remnant gastric cancer.

关 键 词：残胃癌 再次手术 根治性手术 相关因素 

分 类 号：R735.2[医药卫生—肿瘤]