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目的探讨残胃癌的临床病理特征及预后相关因素。方法回顾性分析45例残胃癌患者的临床病理资料,并进行随访。结果45例残胃癌患者的男女比例为44∶1。初次手术距残胃癌的诊断时间为5～42年,平均23年。残胃病变位于吻合口28例,位于贲门9例,其余部位8例。未分化癌1例,低分化腺癌36例,中分化腺癌7例,高分化腺癌1例。根治性切除患者的1、3、5年生存率分别为100．0%、78．8%和47．2%,非根治性切除患者的1、3、5年生存率分别为62．5%、25．0%和0,两组患者生存率差异有统计学意义(P＜0．05)。10例病变未切除患者均于2年内死亡,平均生存时间为12个月。各病理分期患者间生存率差异有统计学意义(P＜0．05)。结论残胃癌多于BillrothⅡ式胃大部切除术后10年以上发生,男性多于女性,病变主要位于吻合口附近。进展期残胃癌病理类型以低分化腺癌常见。残胃癌的预后与病理分期、能否行根治性切除密切相关。
Objective To investigate the clinicopathological features and prognostic factors of gastric stump cancer. Methods Retrospective analysis of 45 cases of gastric cancer patients with clinical and pathological data, and were followed up. Results The ratio of male to female in 45 patients with gastric stump cancer was 44: 1. The first diagnosis of residual gastric cancer surgery for 5 to 42 years, an average of 23 years. Stomach lesions located in anastomotic 28 cases, located in the cardia in 9 cases, the remaining 8 cases. 1 case of undifferentiated carcinoma, 36 cases of poorly differentiated adenocarcinoma, 7 cases of moderately differentiated adenocarcinoma and 1 case of well-differentiated adenocarcinoma. The 1, 3, 5-year survival rates of patients who underwent radical resection were 100.0%, 78.8% and 47.2%, respectively. The 1,3 and 5-year survival rates of patients who underwent radical resection were 62.5% , 25.0% and 0 respectively. The difference of survival rate between the two groups was statistically significant (P <0.05). Ten patients with unresectable disease died within 2 years, with an average survival time of 12 months. There was significant difference in survival rates between different pathological stages (P <0.05). Conclusions Gastric stump cancer occurred more than 10 years after Billroth Ⅱ type subtotal gastrectomy, with more men than women. The lesions mainly located near the anastomosis. Progressive staging of gastric cancer with poorly differentiated adenocarcinoma is common. The prognosis of gastric cancer and staging, whether radical resection is closely related.