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目的探讨残胃癌的临床病理学特征和外科治疗的效果。方法回顾性分析1993-2003年大连医科大学附属第一医院外科收治并获得随访的89例残胃癌(初次手术良性病变组42例,初次手术恶性病变组47例)的临床病理学特征、术后5年存活率和影响预后的因素。结果残胃癌发生部位以吻合口居多,组织学类型以低分化型癌为主。残胃癌的淋巴结转移,No.1、2、3、4、10、11、12淋巴结转移率为30.5%～61.0%,No.14淋巴结为25%。空肠系膜淋巴结转移率为27.3%～50.4%。残胃癌中的Billroth-Ⅰ式重建的No.10、11、12具有高频度的淋巴结转移率,Billroth-Ⅱ式中的空肠系膜淋巴结转移率高达50.4%。残胃癌的周围脏器的直接浸润在Billroth-Ⅰ式胰腺浸润为66.7%,肝十二指肠韧带为33.3%;在Billroth-Ⅱ式病例横结肠浸润为25.0%～28.5%,胰腺浸润为71.4%～75.0%。初次手术良性组的残胃癌5年累积存活率为38.1%,恶性病变组为10.4%。根治度A、B病例的累积5年存活率,初次手术良性病变组为53.6%,恶性病变组为22.2%(P<0.05)。结论残胃癌的淋巴结转移和周围脏器浸润有其独特的方式和规律,外科手术是有效的治疗手段。
Objective To investigate the clinical and pathological characteristics of gastric stump carcinoma and the effect of surgical treatment. Methods The clinicopathological features of 89 gastric cancer patients (42 cases of primary benign lesions and 47 cases of primary malignant lesions) were retrospectively analyzed from 1993 to 2003 in the First Affiliated Hospital of Dalian Medical University. 5-year survival rate and prognostic factors. Results Stomach gastric anastomosis occurred in the majority of sites, histological type to poorly differentiated cancer-based. Stomach cancer lymph node metastasis, No. 1,2,3,4,10,11,12 lymph node metastasis rate was 30.5% ~ 61.0%, No.14 lymph node was 25%. Mesenteric lymph node metastasis rate was 27.3% ~ 50.4%. Billroth-Ⅰ remnant gastric cancer No.10, 11, 12 had high frequency of lymph node metastasis, Billroth-Ⅱ type of mesangial lymph node metastasis rate as high as 50.4%. The direct infiltration of gastric viscera in gastric residual gastric cancer was 66.7% in the Billroth-Ⅰ type pancreatic duct and 33.3% in the hepatoduodenal ligament. In the case of Billroth-Ⅱ type, the infiltration of the transverse colon was 25.0% -28.5% and the pancreatic infiltration was 71.4% ~ 75.0%. The 5-year cumulative survival rate of residual gastric cancer was 38.1% in the primary benign group and 10.4% in the malignant group. The cumulative 5-year survival rate of radical A and B cases was 53.6% in primary benign lesion group and 22.2% in malignant lesion group (P <0.05). Conclusion Stomach cancer lymph node metastasis and infiltration of the surrounding organs have their own unique ways and laws, surgery is an effective treatment.