摘要
目的探讨胃十二指肠溃疡行胃部分切除术后残胃溃疡的临床特点。方法收集2007年1月1日至2013年10月31日期间因良性胃十二指肠溃疡接受胃部分切除术，之后因出现上消化道症状而接受胃镜检查并被诊断为残胃溃疡者272例，其中男237例、女35例，平均年龄为（55．4±13．0）岁。分析残胃溃疡的发生部位、症状和病理组织学变化。计数资料间比较行卡方检验或 Fisher确切概率法分析。计量资料间比较行 t 检验。结果毕Ⅰ式胃大部切除术后残胃溃疡患者进食梗阻感、恶心呕吐、胸骨后痛、胸骨后烧灼感、上腹痛、腹胀、反酸和（或）上腹部烧灼感、呕血和（或）黑便的发生率与毕Ⅱ式胃大部切除术后残胃溃疡患者比较差异均无统计学意义（P 均＞0．05）。毕Ⅰ式胃大部切除术后胃部溃疡和吻合口溃疡的构成比[分别为24．7％（18/73）和72．6％（53/73）]均高于毕Ⅱ式胃大部切除术后[分别为10．1％（20/199）和58．3％（116/199）]，差异均有统计学意义（OR＝2．929和1．896，95％CI 为1．448～5．927和1．055～3．409，χ^2＝9．482和4．649，P ＝0．002和0．031）。毕Ⅱ式胃大部切除术后输入袢输出袢溃疡的构成比与毕Ⅰ式胃大部切除术后十二指肠溃疡的构成比比较差异无统计学意义（P ＝0．619）。毕Ⅰ式胃大部切除术后残胃溃疡的最大径[（1．1±0．7）cm]大于毕Ⅱ式胃大部切除术后[（0．8±0．6）cm]，差异有统计学意义（t＝3．591P ＝0．007）。残胃溃疡患者肠上皮化生和（或）不典型增生的发生率为8．1％（22/272），其在胃部溃疡、吻合口溃疡、鞍部溃疡、输入袢输出袢溃疡中的发生率差异均无统计学意义（P 均＞0．05）。残胃溃疡患者残胃癌的发生率为4．0％（11/272），其在胃部溃疡、吻合口溃疡、鞍部溃疡、输入袢输出袢溃疡中的发生率分别为13．2％（5/38）、2．4％（4/169）、1．8％（1/55）、1/10，胃部溃疡的残胃癌发生率高于吻合口溃疡和鞍部溃疡，差异均有统计学意义（OR ＝6．250和8．182，95％CI 为1．593～24．519和0．915～73．126，χ2＝8．687和4．788，P ＝0．012和0．040），其余各部位溃疡间残胃癌的发生率差异均无统计学意义（P 均＞0．05）。毕Ⅰ式胃大部切除术后残胃溃疡中肠上皮化生和（或）不典型增生的发生率及残胃癌的发生率与毕Ⅱ式胃大部切除术后比较差异均无统计学意义（P ＝0．650和0．733）。11例残胃癌患者中，术后≤20年、＞20年且≤30年、＞30年者分别有1、3、7例。结论残胃溃疡患者肠上皮化生和（或）不典型增生及残胃癌的发生率均较高，残胃癌好发于残胃端。
Objective To investigate the clinical features of gastric stump ulcer （GSU）after partial gastrectomy due to gastroduodenal ulcer.Methods From January 1st 2007 to October 31th 2013,272 patients with partial gastrectomy for gastroduodenal ulcer underwent gastroscopy due to upper gastrointestinal symptoms were collected.Among them,there were 237 male patients and 35 female patients with the average age （55 .4 ± 13.0 ）years.The lesion location,symptoms and pathological changes of GSU were analyzed.Chi-square test and Fisher exact probability analysis were used for count data comparison.The t test was performed for measurement data comparison.Results There was no significant difference between patients with GSU after Billroth Ⅰ gastrectomy and Billroth Ⅱ gastrectomy in the incidence of dysphagia,nausea and vomiting,retrosternal pain,retrosternal buring sensation,upper abdominal pain, abdominal distention, acid regurgitation and （or） epigastric buring sensation, hematemesis and （or）melena （all P〉0.05 ）.The proportion of ulcer located in remnant stomach and anastomotic stoma of patients with Billroth Ⅰ gastrectomy （24.7%,18/73 and 72.6%,53/73 ）was higher than those of patients with Billroth Ⅱ gastrectomy （10.1 %,20/199 and 58.3%,116/199 ）and the difference was statistically significant （OR=2.929 and 1 .896,95 %CI ：1 .448 to 5 .927 and 1 .055 to 3.409,χ^2 =9.482 and 4.649,P =0.002 and 0.031 ）.There was no significant difference between the proportion of afferent loop and efferent loop ulcer in patients with Billroth Ⅱ gastrectomy and the proportion of duodenal ulcer in patients with Billroth Ⅰ gastrectomy （P =0.619）.The diameter of GSU of patients with BillrothⅠ（（1.1±0.7）cm）was larger than that of ulcer of patients with BillrothⅡ（（0.8±0.6）cm） and the difference was statistically significant （t = 3.591 ,P = 0.007 ）.The incidence of intestinal metaplasia and atypic hyperplasia of GSU was 8.1 % （22/272）,and there was no significant difference in gastric ulcer,stoma ulcer,nek ulcer,afferent loop and efferent loop ulcer （all P 〉0.05）.The incidence of gastric stump cancer of GSU was 4.0% （11/272）and that of gastric ulcer,stoma ulcer,nek ulcer,afferent loop and efferent loop ulcer was 13.2% （5/38 ）,2.4% （4/169 ）,1.8% （1/55 ）and 1/10,respectively.The incidence of gastric stump cancer of gastric ulcer was significantly higher than that of stoma ulcer and nek ulcer, the differences were statistically significant （OR =6.250 and 8.182,95%CI ：1.593 to 24.519 and 0.915 to 73.126,χ^2 =8.687 and 4.788,P =0.012 and 0.040）.There was no statistically significant difference in the incidence of gastric stump cancer of GSU in other gastric parts （all P 〉 0.05 ）.There was no statistically significant difference in the incidence of intestinal metaplasia,atypic hyperplasia and gastric stump cancer between case with BillrothⅠgastrectomy and case with Billroth Ⅱ gastrectomy （P =0.650 and 0.733）.Among the 11 gastric stump cancers,the number of cases with the onset time with 20 years,20-30 years and beyond 30 years after gastrectomy were one,three,seven,respectively.Conclusion The incidence of intestinal metaplasia, atypic hyperplasia and gastric stump cancer of patients with GSU was high,and the predilection site of GSU was the remnant stomach.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2014年第9期593-596,共4页
Chinese Journal of Digestion
基金
江西省自然科学基金（20122BAB215010）
关键词
残胃溃疡
肠化
不典型增生
残胃癌
Gastric stump ulcer
Intestinal metaplasia
Dysplasia
Gastric stump cancer
