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残胃癌外科治疗回顾性临床研究

Retrospective clinical analysis of surgical treatment for gastric stump carcinoma

摘要:

目的 探讨残胃癌的临床特点、外科治疗方法及预后影响因素.方法 收集解放军总医院1990年1月至2012年12月行R0切除治疗的167例残胃癌患者的临床资料.其中男性144例,女性23例.因良性疾病行远端胃大部切除术后残胃癌患者78例(GSC-B组),因恶性疾病行远端胃大部切除术后残胃癌患者89例(GSC-M组).采用t检验、x2检验比较两组患者的临床病理学特点,采用Kaplan-Meier方法统计残胃癌术后生存率,采用Cox比例风险模型进行生存预后多因素分析.结果 GSC-B组初次行胃大部切除术和残胃手术之间的时间间隔更长[(28.2±10.2)年比(l0.8±1.0)年,t=15.902,P=0.001].两组初次手术吻合方式有明显差异(x2=25.77,P=0.001),GSC-B组以毕Ⅱ式为主,GSC-M组以毕Ⅰ式为主.GSC-B组残胃癌主要位于吻合口,GSC-M组主要位于非吻合口的部位(x2 =6.975,P=0.031).167例残胃癌患者术后l、3和5年生存率分别为87%、60%和41%.不同TNM分期的5年生存率分别为Ⅰ期65%、Ⅱ期43%、Ⅲ期22%.多因素生存分析结果显示,小肠或食管浸润(HR=1.957,95%CI:1.096~3.494,P=0.023)、肿瘤部位(HR=1.618,95%CI:1.104~2.372,P=0.014)及TNM分期(HR =2.307,95% CI:1.708~3.118,P=0.001)为残胃癌患者预后的独立危险因素.胃周淋巴结(56.3%)、吻合口处空肠周围及肠系膜淋巴结(65.2%)的转移率较高.结论 因恶性疾病行胃大部切除的患者残胃癌出现的时间早于因良性疾病行胃大部切除的患者.早期发现残胃癌并行残余淋巴结清扫的根治性手术在改善患者预后方面有重要的意义.小肠或食管浸润、肿瘤部位及TNM分期是残胃癌患者预后的独立危险因素.

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abstracts:

Objectives To investigate the clinical feature and surgical procedures of gastric stump carcinoma (GSC) and to identify the prognostic factors which influence survival rate of GSC patients.Methods Clinical data of 167 patients who underwent R0 resection for gastric stump carcinoma at Chinese People's Liberation Army General Hospital between January 1990 and December 2012 was collected.There were 144 male and 23 female cases.The clinicopathological features of GSC patients were compared between those who underwent initial surgery for benign disease (GSC-B group,78 cases) and for gastric cancer (GSC-M group,89 cases).The analysis of therapeutic methods and survival time were also performed.t-test was used to compare the quantitative data between two groups.Pearson x2 test was used to compare the various clinicopathological characteristics between the two groups.Kaplan-Meier method was used to analyze the survival rate.Multivariate survival analysis was based on the Cox proportional hazard model.Results Compared with GSC-M group,the interval time between initial gastrectomy and surgery in GSC-B group was longer ((28.2 ± 10.2) years vs.(10.8 ± 1.0) years,t =15.902,P =0.001).There were 56 patients (71.8%) who received Billroth Ⅰ reconstruction in GSC-B group,and 49 patients (55.1%) who received Billroth Ⅱ reconstruction in GSC-M group,the difference of anastomosis method between the two groups was statistically significant (x2 =25.770,P =0.001).Compared with GSC-M group,the tumor of GSC-B group was usually located at the anastomotic site (x2 =6.975,P =0.031).The overall 1-,3-,and 5-year survival rates of the 167 patients were 87%,60%,and 41%.The 5-year survival rates for TNM stages Ⅰ,Ⅱ,and Ⅲ were 65%,43%,and 22%,respectively (P =0.001).Multivariate analysis showed that small intestinal or esophageal infiltration (HR =1.957,95% CI:1.096 to 3.494,P =0.023),tumor location (HR =1.618,95% CI:1.104 to 2.372,P =0.014),and TNM stage (HR =2.307,95% CI:1.708 to 3.118,P =0.001) have independent effect on survival.The metastasis rates of perigastric lymph nodes,jejunum anastomosis and mesenteric lymph nodes were very high (56.3% and 65.2%,respectively).Conclusions The GSC appears earlier in patients with gastrectomy for malignant disease than those with benign disease.Appropriate curative resection including residual lymph node dissection is very important to improve the prognosis.Small intestinal or esophageal infiltration,tumor location,and TNM stage have independent effect on survival.

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作者: 郗洪庆 [1] 崔建新 [1] 胡翀 [1] 马连港 [1] 卫勃 [1] 陈凛 [1]
第一作者: 郗洪庆
期刊: 《中华外科杂志》2016年54卷3期 182-186页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2016.03.006
发布时间: 2016-03-31
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