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目的分析残胃癌的外科治疗及其临床病理特征,对当前残胃癌外科治疗进行再认识。方法回顾性总结我院2004年1月至2011年3月期间经内镜和病理学检查诊断为残胃癌并行外科治疗的26例患者的临床资料,其中首次疾病为良性的残胃癌(RGCB)者14例,胃癌根治术后残胃癌(RGCC)者12例,对其临床发病、HP感染、手术方式、组织病理学特点及预后因素进行分析。结果 RGCB距第1次胃切除术后的发病时间为15～44年(中位时间为26.3年),RGCC距第1次胃切除术后的发病时间为1~10.5年(中位时间为4.0年),两者间差异有统计学意义(P<0.05)。病理检测残胃癌的HP感染率为73.1%(19/26),其中RGCB的HP感染率为71.4%(10/14),RGCC的HP感染率为75.0%(9/12),两者间差异无统计学意义(P>0.05)。26例患者均再次进行了手术治疗,其残胃癌手术根治率为46.2%(12/26),其中RGCB根治切除率为57.1%(8/14),RGCC根治切除率为33.3%(4/12),两者间差异无统计学意义(P>0.05)。在行根治性切除的12例患者中胃周淋巴结转移以小弯淋巴结转移率最高(83.3%,10/12),其次为空肠系膜淋巴结(33.3%,4/12)和脾门淋巴结(33.3%,4/12)。26例残胃癌术后病理分期:Ⅰ期3例,Ⅱ期2例,Ⅲ期14例,Ⅳ期7例。18例手术切除者术后病理报告提示有13例(72.2%)发生淋巴结转移;明确肿瘤侵犯胰腺或横结肠或脾脏者13例(50.0%);8例有腹膜转移(30.8%),其中RGCB的腹膜转移率为14.3%(2/14),明显低于RGCC的腹膜转移率(50.0%,6/12),P<0.05。全组病例累积1年总体生存率为54.5%,3年生存率为38.5%,生存时间为2～61个月(中位生存时间12个月)。生存分析结果表明,肿瘤的病理分期与是否接受根治性手术为残胃癌患者生存的影响因素(P<0.01),而患者年龄、性别、第1次疾病、病理分化程度以及HP感染均不是影响预后的相关因素(P>0.05);是否接受根治性手术为影响生存的独立预后因素(P<0.05)。结论早期诊断和根治手术是改善残胃癌患者预后的关键因素,腹腔镜探查可减少不必要的外科手术创伤。胃癌术后残胃癌与良性疾病后残胃癌在临床特点上不同,临床处理仍需区别对待。
Objective To analyze the surgical treatment of residual gastric cancer and its clinicopathological features and to re-understand the current surgical treatment of gastric residual gastric cancer. Methods A retrospective clinical data of 26 patients in the surgical treatment for concurrent remnant gastric cancer in our hospital during January 2004 to March 2011 by endoscopy and pathology diagnosis, which for the first time the disease is benign gastric residual (RGCB) who Fourteen cases, 12 cases of residual gastric cancer (RGCC) after radical operation of gastric cancer, analyzed their clinical onset, HP infection, operation mode, histopathological features and prognosis. Results The onset time of RGCB after first gastrectomy was 15-44 years (median time was 26.3 years). The incidence of RGCC from the first gastrectomy was 1-10.5 years (median 4.0 Year), the difference was statistically significant (P <0.05). The HP infection rate of gastric cancer was 73.1% (19/26). The HP infection rate of RGCB was 71.4% (10/14) and the HP infection rate of RGCC was 75.0% (9/12), the difference between the two No statistical significance (P> 0.05). Twenty-six patients underwent surgery again. The cure rate of gastric cancer was 46.2% (12/26). The radical resection rate of RGCB was 57.1% (8/14) and the radical resection rate of RGCC was 33.3% (4/12 ), No significant difference between the two (P> 0.05). Among the 12 patients who undergone radical resection, the rate of lymph node metastasis in gastric cancer was the highest (83.3%, 10/12), followed by mesangial lymph nodes (33.3%, 4/12) and splenic lymph nodes (33.3% , 4/12). Pathological staging of 26 cases of residual gastric cancer after surgery: Ⅰ in 3 cases, Ⅱ in 2 cases, Ⅲ in 14 cases, Ⅳ in 7 cases. 18 cases after surgical resection pathology reports suggest that 13 patients (72.2%) lymph node metastasis; transverse colon, or pancreatic tumor invasion explicitly or spleen in 13 cases (50.0%); 8 patients had peritoneal metastasis (30.8%), wherein the RGCB Peritoneal metastasis rate was 14.3% (2/14), which was significantly lower than that of RGCC (50.0%, 6/12), P <0.05. The overall 1-year overall survival rate was 54.5%, the 3-year survival rate was 38.5%, and the survival time ranged from 2 to 61 months (median survival 12 months). Survival analysis showed that pathological stage and whether to accept the radical surgery of tumors as influencing factors (P <0.01) residues of gastric cancer patients survive, and the patient’s age, sex, the first time the disease, pathological grade and HP infection was not a prognostic (P> 0.05). Whether they accepted radical surgery was an independent prognostic factor for survival (P <0.05). Conclusion Early diagnosis and radical surgery are the key factors to improve the prognosis of patients with residual gastric cancer. Laparoscopic exploration can reduce unnecessary surgical trauma. Postoperative gastric cancer residual gastric cancer and benign disease residual gastric cancer in clinical features are different, the clinical treatment still need to be treated differently.