胃肝样腺癌的九例临床分析  

Hepatoid adenocarcinoma of stomach:A report of 9 cases

作　　者：张峥嵘[1] 武健[1] 

机构地区：[1]皖南医学院附属弋矶山医院胃肠外科,安徽芜湖241000

出　　处：《遵义医学院学报》2016年第3期310-313,共4页Journal of Zunyi Medical University

摘　　要：目的探讨胃肝样腺癌（hepatoid adenocarinoma of stomach,HAS）的临床特点及诊断治疗和预后。方法回顾分析2012年1月至2016年3月我院9例诊断为胃肝样腺癌患者的相关症状体征、术前影像学以及AFP检查情况、手术情况、术后病理及随访预后等相关资料。结果 9例肝样腺癌患者主诉缺乏特异性,症状多样;治疗前血清AFP升高7例,8例患者肿瘤均位于胃窦部及胃体部,胃镜病理活检显示低分化腺癌2例、中-低分化腺癌7例;腹部CT均发现局部胃壁增厚,4例患者胃周可见肿大淋巴结;行根治性手术患者8例,大体标本均为溃疡型,临床病理分期III期3例、IV期4例,1例患者术后时间较短无法随访预后,截止到末次随访时1例患者存活12月,另外7例患者在接受手术及化疗后,AFP持续或再次升高,均未能获得长期生存（生存期为5～32个月）。结论胃肝样腺癌是一类特殊胃癌,容易发生淋巴结以及肝脏转移,发现时多已是晚期,临床疗效差,外科医师应予以重视。Objective To explore the clinical characteristics of hepatoid adenocarcinoma of stomach（HAS） and its diagnosis,treatment and prognosis.Methods Retrospective analysis in January 2012 to March 2016 of 9 cases diagnosed as HAS associated symptoms and signs of patients,preoperative imaging and AFP cases,surgery,postoperative pathological and follow-up data related to prognosis were performed.Results The mean age of the9 cases was 61.6 years,in which 8 cases were male.Before treatment the serum AFP rise in 7 cases,8 cases located in the distal and gastric body,gastroscope pathological results：2 patients were of low differentiation and 7patients were of middle low differentiation;Abdominal CT have found local stomach wall thickening,enlarged lymph nodes visible around the stomach in 4 cases.8 cases were performed surgery,radical surgery,gross specimen were ulcer type,clinical pathologic staging for stage III in 3 cases,stage IV in 4 cases.For follow-ups,1patient of shorter postoperative time was unable to follow-up.As of the last follow-up,1 patient survived for 12months;The other 7 patients after surgery and chemotherapy,AFP continued or increased again,failed to achieve long-term survival（survival period of 5-32 months）.Conclusion HAS is A special kind of cancer of the stomach,prone to lymph node and liver metastasis,HAS is often detected in late stages,the clinical curative effect is poor.Surgeons should take it seriously.

关 键 词：胃肿瘤 肝样腺癌 甲胎蛋白 

分 类 号：R735.2[医药卫生—肿瘤]