The Clinical Analysis Of50Patients Of Gastric Stump Cancer

Objective： Gastric stump cancer is the serious complication of subtotalgastrectomy. This article aims to improve the level of recognition and do well in earlydiagnosis by analyzing and discussing clinical features and the relationship between thesize, depth of infiltration, and metastasis of gastric stump cancer.Methods：The clinical data of fifty cases with gastric stump carcinoma from thesecond affiliated hospital of Dalian Medical University were obtained during the periodfrom1999to2012were retrospectively analyzed. Gender, age, cause of the initialoperation, method of the initial operation, time interval between the initial operation anddiagnosis of gastric stump cancer, clinical manifestations, the related examinations,infection of the helicobacter pylori, the size, depth of infiltration and metastasis of thecancer were observed. Statistic analysis was completed with SPSS17.0.Results：1. General information: There were44males(88%)and6females(12%) with ageof41～81years old and about65years old on average.28cases were older patients,account for56%. The time interval was between5and50years (26years on average).The time interval of33cases were more than20years, account for66%. There were44cases (88%) received surgical treatment because of benign disease, while6cases (12%)received surgical treatment duo to malignant disease.39cases (78%) operated withBillrothⅡ reconstruction,11cases (22%) operated with BillrothⅠreconstruction.2. Clinical manifestations: Clinical symptoms were not typical. The mostcommon symptom were weight lose (64%) and appetite lose (58%) followed byabdominal pain (52%), abdominal distention (48%) and others.3. Endoscopic examination: The diagnose rate of endoscopic and biopsy is96%.In this study, one case was found to be early gastric stump cancer,49cases wereadvanced gastric stump cancer. In advanced gastric stump cancer cases, BorrmannⅡtype account for36.7%，Borrmann Ⅲtype account for40.8%. A total of32(64%) lesions were located at the stomas. The rate of stomas that happened betweengroup BillrothⅠand group BillrothⅡ were statistically significant (P<0.05).21casestested the Helicobacter Pylori, all of the results were positive.4. Other auxiliary examination: The positive rate of X-ray is66.67%, thepositive rate of abdominal CT is75%. The positive rate of abdominal ultrasound is42.3%. Tumor markers CEA、 CA125、 CA199、 CA724increased differently.Hemoglobin decreased in41cases (82%), total protein decreased in27cases (54%),albumin decreased in30cases (60%).5. Size, depth of infiltration and metastasis of the cancerThe tumor size of50cases was recorded. According to the maximum diameter,50cases were divided into3groups. The metastasis of the cancer between group3～5cmand group≤3cm were not statistically significant (P>0.05), and between the group3～5cm and group>5cm were not statistically significant (P>0.05), but there wassignificant difference between group≤3cm and group>5cm(P<0.05).The depth of infiltration (48cases) was recorded. According to the mucous andsubmucosa, muscular, and serosa, we divided them into3groups. The metastasis ofcancer between group mucous and submucosa and group muscular were not statisticallysignificant (P>0.05), but there were significant difference between group mucous andsubmucosa and group serosa(P<0.05),and between group muscular and group serosa(P<0.05).Conclusions：1. There were more males than females suffered this disease, clinical symptomswere not typical, endoscopy and gastric biopsy are the main means of confirming thegastric stump cancer.2. The probability of metastasis increased by the enlargement of diameter anddeepening of infiltration.3. In this study, the result of statistical information pointed out that it is possiblethat the cancer often happened in stomas after BillrothⅡoperation compared withBillrothⅠoperation.