戴伟令　谭曙光　尹　军　李　兵

【摘要】 目的 探讨残胃癌的临床特点、诊断和外科治疗。方法 回顾性分析本院14例残胃癌的临床特点、诊断以及外科治疗，并结合随访资料与同期收治的其他胃癌625例对比。结果 本组病例中男性占绝大部分(12/14)，平均59．6岁，首次手术以因胃溃疡行BillrothⅡ吻合为主，64．29%发病在吻合口，再次手术切除率为71．43%，根治性切除率为42．86%，并发症发生率为14．29%，与同期其他胃癌(5．92%)相比差异无统计学意义(P=0．196)；总1、3、5年生存率分别为79%、29%、14%，与同期其他胃癌对比(75%、47%、27%)差异无统计学意义(P=0．543)。结论 残胃癌手术治疗安全有效。

【关键词】 残胃癌;外科治疗

Castric remnant carcinoma diagnosis and surgical treatment

DAI Wei-ling,TAN Shu-guang,YI jun,et al.Hengyang Centre Hospital,Hunan 421001,China

【Abstract】 Objective To analyze the clinical features，diagnosis and,surgical treatment of gastric remnant carcinoma.Methods Fourteen cases of gastric remnant carcinoma admitted in our hospital were analyzed for the clinical features,diagnosis,surgical treatment and follow-up data retrospectively,and were compared with 625 cases of other gastric cancers in the same time period.Results In gastric remnant carcinoma group,most majority of the patients were male(12/14),the average age was 59．6,first-operation in most of patients was BillrothⅡprocedure for gastric ulcer,in 64．29%of the patients the tumor located in the anastomotic stoma,removal rate was 71．43%and radical resection rate was 42．86%,the incidence of postoperative complications in gastric remnant carcinoma group was 14．29%,while the control group was 5．92%,there were no statistical differences between them(P=0．196); In gastric remnant carcinoma group,overall 1、3、5-year survival rate was 79%、29%、14%respectively,compared with the control group(75%,47%,27%,respectively),there was no statistical difference(P=0．543).Conclusion Surgical treatment for gastric remnant carcinoma is safe and effective.

【Key words】 Gastric remnant carcinoma；Surgical treatment

由于20世纪70年代前后胃大部切除术的盛行以及对残胃这种特殊的癌前状态认识的加深，近年来残胃癌的发病率逐年增高，国内报道为0．3%~13%。本院于1992年4月至2005年10月对14例残胃癌进行了外科手术治疗，结合文献现报告如下。

1 临床资料

1．1 一般资料 14例残胃癌患者,占同期收治胃癌患者的2．24%(14/625)其中男12例，女2例，年龄46~70岁，平均59．6岁。首次手术均为胃大部分切除(BillrothⅡ式11例，BillrothⅠ式例)，其中胃溃疡12例，十二指肠溃疡2例。临床表现：上腹不适、腹痛、胸骨后烧灼感及其他消化道症状如恶心、呕吐、反酸、嗳气、黑便等，晚期病例则表现为贫血、进行性消瘦和恶病质。残胃癌发现时间为术后12~32年，其中12~15年3例，16~25年9例，26~32年2例。

1．2 诊断及病理类型 所有病例均常规行上消化道钡餐和胃镜检查。胃镜检查经活检证实为残胃癌11例，消化道钡餐检查，仅5例诊断为残胃癌。9例(64．29%)肿瘤发生部位位于吻合口,残胃前壁2例,残胃小弯侧1例(均经术中证实)。……