腹腔镜Roux-en-Y胃旁路术后胃癌的发生情况:一项系统综述  

Occurrence of gastric cancer after laparoscopic Roux-en-Y gastric bypass: a systematic review

作　　者：董世梁 梁亚伦 王存川[1] 董志勇 Dong Shiliang;Liang Yalun;Wang Cunchuan;Dong Zhiyong(Department of Gastrointestinal Surgery,Department of Bariatric Surgery,the First Affiliated Hospital,Jinan University,Guangzhou 510630,China)

机构地区：[1]暨南大学医学院第一附属医院胃肠外科一区肥胖代谢外科(减重中心),广州530610

出　　处：《中华胃肠外科杂志》2022年第9期834-839,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：暨南大学人才引进科研启动项目(702016)。

摘　　要：腹腔镜Roux-en-Y胃旁路术(RYGB)是重要的减重术式之一。RYGB与残胃癌发生风险之间的关系, 越来越受到减重外科医生以及肥胖症人群的关注。本文系统分析国内外主要医学数据平台与RYGB术后发生胃癌相关的文献发现, 21例RYGB胃旁路术后相关胃癌的患者从接受RYGB到诊断为肿瘤的中位时间为11(1~28)年, 症状的持续时间为7 d至6年, 其中最常见的症状是腹痛(71.4%), 尤其是上腹部(33.3%), 其次为恶心和呕吐(33.3%)、体质量过度减轻(33.3%)以及腹胀(28.6%)等。肿瘤多位于胃窦或幽门(71.4%), 腺癌是最常见的肿瘤组织类型(71.4%), 以Ⅲ~Ⅳ期为主, 38.1%的患者肿瘤无法完全切除, 52.4%患者接受了胃次全切除术和淋巴结切除术。关于RYGB术后发生胃癌的术前病史, 一项有关64例食管胃癌患者的全球性报道发现, 常见术前病史包括抽烟(37.5%)、饮酒史(14.0%)、胃食管反流病症状(86.0%)、存在Barrett食管(10.9%)、有其他恶性肿瘤的个人病史(6.3%)、一级亲属(6.3%)或其他家族成员(1.6%)有胃食管恶性肿瘤的家族史。虽然RYGB术后胃癌的发生很少见, 但随着越来越多的患者采用RYGB来治疗肥胖及其代谢病, 需警惕高危患者术后发生肿瘤的风险。Laparoscopic Roux-en-Y gastric bypass(RYGB)is an important obesity surgery.The risk of remnant gastric cancer after RYGB for obesity is gaining growing attention from bariatric surgeons and patients with obesity.This systematic review included articles from major databases internationally and domestically that specifically described the remnant gastric cancer after RYGB intervention,a total of 21 cases was subsequently analyzed.The average median time from post-operative RYGB to diagnosis of gastric cancer was 11 years(1-28 years),the duration of gastric cancer symptoms lasted 7 days to 6 years,abdominal pain is the most common(71.4%),especially in the upper abdomen(33.3%),followed by nausea and vomiting(33.3%),over-weight loss(33.3%),and abdominal bloating(28.6%),etc.Neoplasm location was reported to occur in the antrum or the pre-pyloric region(71.4%),with adenocarcinoma being the most common tumor histology observed(71.4%),tumor stage III-IV as the most diagnosed,38.1%of tumor were deemed to be unresectable,52.4%of the patients performed subtotal gastrectomy and lymphadenectomy.In addition,a global article investigating the occurrence of esophageal gastric cancer after RYGB in 64 cases revealed the common preoperative medical history include smoking habits(37.5%),alcohol issues(14.0%),GERD(86.0%),presence with Barret esophagus(10.9%),patients that has other malignant tumor medical history(6.3%),first-degree relatives(6.3%),or other family members with gastric esophagus cancer family history.Although the incidence of gastric cancer after RYGB is rare,the increasing prevalence of gastric cancer development is one of great concern.A rise in clinical cases of patients treated with RYGB presents a target for future studies.Risk of gastric cancer after RYGB should be evaluated and considered in high-risk cases.

关 键 词：ROUX-EN-Y胃旁路术 减重手术 残胃癌 胃肿瘤 文献分析 

分 类 号：R735.2[医药卫生—肿瘤]