贵州医科大学学报

2019, v.44;No.227(08) 971-975+979

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92例残胃癌的临床病理特征及预后
Clinicopathological Features and Prognosis of 92 Cases of Gastric Stump Carcinoma

刘万鲁,李永柏,王润华
LIU Wanlu,LI Yongbai,WANG Runhua

摘要(Abstract):

目的:分析首次胃良、恶性疾病术后残胃癌(GSC)的临床病理特征及预后。方法:收集92例GSC临床资料,良性疾病行远端胃大部切除术后的GSC患者33例为GSC-B组、恶性疾病行远端胃大部切除术后的GSC患者59例为GSC-M组,比较两组患者首次胃手术后诊断GSC间隔时间、首次手术的吻合方式、GSC肿瘤部位、肿瘤大小、肿瘤组织病理分化程度、病理分期(TNM)、治疗方式等临床病理特征,对两组患者进行生存分析并比较生存率。结果:纳入的GSC患者占同期所有胃癌患者的5.90%,两组GSC患者在组织学T分期(P=0.219)、术后淋巴结分期、淋巴结阳性率、术后TNM分期、理分化程度、复发时间、术后远处转移及转移时间、淋巴转移、住院时间比较,差异无统计学意义(P>0.05),GSC-M组5年生存率低于GSC-B组(P<0.05);GSC-B组CA19-9升高患者比例高于GSC-M组(P=0.015);92例GSC患者5年累积生存率为34.3%;GSC-B与GSC-M整体5年累积生存率分别为56.5%及27.3%,两组比较,差异有统计学意义(P=0.029);Cox回归分析结果显示,根治性切除、病理T分期T3/T4、淋巴结阳性及低分化是GSC预后的独立危险因素(P<0.05)。结论:恶性疾病行胃大部切除术后GSC发生的时间早于因良性疾病行胃大部切除术后,预后差,根治性切除、T3/T4、淋巴结转移及低分化是GSC患者预后独立危险因素。
Objective: To investigate the differences in the clinicopathological features and prognosis of gastric stump carcinoma(GSC) following subtotal gastrectomy for gastric malignant cancer and gastric benign cancer.Methods:Clinical data of 92 GSC patients was collected.The clinicopathological features of GSC patients received remote end subtotal gastrectomy for benign disease as GSC-B group(33 cases) and for malignant disease as GSC-M group(59 cases).Comparing diagnosing GSC interval time after initial gastrectomy,anastomosis after initial gastrectomy,GSC tumor location,size,Edmondson-Steiner of tumor histology,TNM and treatment,survival analysis was carried out and comparing survival rate.Results:Research subjects accounted for 5.9% of the total patients with gastric cancer;compared pathological T staging(P=0.219),postoperative staging,lymph node positive rate,postoperative TNM staging,Edmondson-Steiner,total drainage 3 d after surgery,average recurrence time and postoperative distant metastasis mean transfer time,differences showed no statistical significance(P>0.05).Improved CA19-9 patients proportion in GSC-B group was higher than that of GSC-M group(P=0.015);total survival rate after 5 years was 34.3%;total 5 year survival rate of GSC-B and GSC-M were 56.5% and 27.3% respectively,comparison showed significant statistical difference(P=0.029).Cox regression analysis indicated that radical resection,pathological T staging T3/T4,lymph node positive rate and minor differentiation are the GSC independent prognosis factors(P<0.05).Conclusions:The GSC appears earlier in patients with gastrectomy for malignant disease than those with benign disease,with poor prognosis.Radical resection T3/T4,lymph node transfer and minor differentiation are independent risky factor for GSC patients prognosis.

关键词(KeyWords): 残胃癌;肿瘤,良性,恶性;临床病理特征;预后;累积生存率;手术治疗
gastric stump carcinoma;tumor,benign,malignant;clinicopathological features;prognosis;total survival rate;operative treatment

Abstract:

Keywords:

基金项目(Foundation): 贵州省高层次留学人才创新创业项目[留学人才择优资助合同(2018)04]

作者(Author): 刘万鲁,李永柏,王润华
LIU Wanlu,LI Yongbai,WANG Runhua

DOI: 10.19367/j.cnki.1000-2707.2019.08.021

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