【作者】 丁相福；

【导师】 王庆国；

【作者基本信息】 吉林大学 ， 临床医学， 2004， 硕士

【摘要】 残胃癌(gastric stump cancer,GSC)系指因胃十二指肠溃疡行胃大部切除5年以上，残胃发生的原发癌。现大多数人则认为,各种原因所致的胃十二指肠良性疾病行胃大部切除术后至少5年以上、恶性病变术后10年以上，于残胃发生的癌肿称为残胃癌。残胃癌早期诊断率低,且缺乏较典型的临床症状，故大多数病人就诊时已属晚期,因此残胃癌的根治性切除率和长期生存率均低于原发性胃癌。残胃癌作为胃术后远期常见并发症之一，应引起临床的高度重视。针对残胃癌的研究，大多数学者认为行Billroth II式手术的患者术后发生残胃癌的风险远较行Billroth I式手术的患者高，有人综合国内外文献发现70%～100%残胃癌发生于Billroth II 式吻合术后。 残胃癌可发生于残胃的任何部位,尤以发生在吻合口胃侧为多见,有人统计可高达86%～91%。残胃癌应注重其早期诊断，治疗仍以外科治疗为主，辐以放疗、化疗、免疫治疗及其它辅助治疗。一旦确诊只要全身情况许可，均应剖腹探查，争取根治切除，即使姑息性切除或改道手术，也可为非手术创造条件。综合以往文献报 道,残胃癌的预后很差,其5年存活率仅为3.4%～11%, 但随着近年来残胃癌的根治性切除疗效得到肯定，一些报道认为残胃癌施行治愈性切除者，其5年生存率与原发胃癌无明显差别，未浸浆膜残胃癌的5年生存率可达70%以上，但浸出浆膜病例仅为16%。说明残胃癌病例施行彻底的根治术，仍有望获得较好的生存率。我院1960-1999年来所收治的残胃癌患者共147例，其中行<WP=44>手术治疗者130例，术后有随访信息记载者共60例，本文对此60例患者进行回顾性分析，按首次术式的不同将其分为两组，按首次术式的不同将其分为两组，即首次术式为Billroth Ⅰ式组（简称 B I组）和首次术式为BillrothII式组（简称B II组）。其中，B I组13例，占总数的21.67%，术后1、3、5年的总生存率分别为76.92%（10）、46.15%（6）、38.46%（5），行根治性手术10例，占B I组的76.92%，术后1、3、5年生存率分别为90%（9）、60%（6）、50%（5）；行姑息性手术3例，占B I组的23.08%，术后1、3、5年生存率分别为33.33%（1）、0%、0%。B II组47例，占总数的78.33%，术后1、3、5年的总生存率分别为68.09%（32）、36.17%（17）、21.28%（10），行根治性手术28例，占B II组的59.57%，术后1、3、5年生存率分别为100%、60.71%(17)、35.71%（10）；行姑息性手术19例，占B II组的40.43%，术后1、3、5年生存率分别为21.05%（4）、0%、0%。结果发现：首次术式为BillrothII式者占78.33%，与国内外学者的研究结果相符合，两组病例行残胃癌手术治疗术后远期生存率按统计学检验无明显差异。因此得出以下结论：首次术式为BillrothII式者术后残胃癌的发病率明显高于首次术式为BillrothI式者，首次术式为BillrothI式的残胃癌患者在行残胃癌手术后其远期生存率与首次术式BillrothII式的残胃癌患者在行残胃癌手术后远期生存率无显著差异。更多还原

【Abstract】 Objective: To verify the incidence of the gastric stump cancer after BillrothII operation is higher than that of BillrothI type ; and compare the living rate after operation for gastric stump cancer between the patients who had got BillrothII operation and those who had got BillrothI operation. Method: There were 147 cases who had got treatment in our hospital from 1960-1999, in them , 130 patients had got operation, and from 60 cases we had received the healthy messages. I reviewed analyzed these 60 patients. According to the types of first operation, we divide the 60 patients to two groups. We make the patients who had got BillrothI operation for No.1 group (abbreviation BI group), and we make the patients who had got BillrothII operation for No.2 group (abbreviation BII group). Result: It has 13 patients in BI group, 21.67% of the total numbers, in them,10 had got complete dissection and 3 for appeased operation . The total living rate for 1、3、5 years after operation for gastric stump cancer is 76.92%、46.15%、38.46%,the rates are 90%、60%、50% for the patients who had got complete dissection, and 33.33%、0%、0% for appeased ones. It has 47 patients in BII group, 78.33% of the total numbers, in them, 28 had got complete dissection and 19 for appeased operation . The total living rate for 1、3、5 years after operation for gastric stump cancer is 68.09%、36.17%、21.28%,the rates are 100%、60.71%、35.71% for the patients who had got complete <WP=46>dissection, and 21.05%、0%、0% for appeased ones. We can see that the incidence of gastric stump cancer after BillrothII operation is obviously higher than that after BillrothI operation. But the living rate after operation for gastric stump cancer have no difference according to the statistics analysis. Conclusion: First operation type can affect the incidence of gastric stump cancer, the type of BillrothII can cause a apparently higher incidence than BillrothI type, but there is no differently living rate between the two groups after operation for gastric stump cancer, seldom GSC patients had had the first operation type as Roux-en-Y.更多还原