作者：朱冠烈

单位：广西钦州市第二人民医院 普外科，广西 钦州 535000

Authors:  ZHU Guanlie

Unit:  Institute of General Surgery, the Second People's Hospital of Qinzhou City, Qinzhou 535000, Guangxi, China

摘要：

目的   分析胃癌脐转移的临床特点和诊治疗效,提高临床诊治水平。方法  回顾性分析1994年1月至2019年1月在广西钦州市第二人民医院诊治的胃癌脐转移病例,同时检索Pub Med、Cinii、CNKI、万方、维普数据库上胃癌脐转移的文献,筛选符合文献质量评价标准的文章,提取相关数据进行统计分析。结果  共纳入18篇文献,加上本院符合条件患者1名,共24例纳入分析。本组患者平均年龄57.9±15.6岁,中位发病时间11.0个月,14例(58.3%)以脐部肿物或脐部其他相关症状为首发症状;4例(16.7%)误诊为脐部肿物或感染;脐转移瘤直径1.2～8 cm,平均2.9±1.5 cm。14例(58.3%)患者同时存在腹膜种植转移,3例(12.5%)肝转移,2例(8.3%)肺转移、1例(4.2%)肝圆韧带转移。原发胃癌病理中的中低分化病例占80.0%(16/20),脐转移瘤中的分化程度低病例占87.5%(7/8)。本组患者总体生存时间0.5～36个月,中位生存时间为8.5个月,1年生存率57.0%,2年生存率34.2%,3年生存率22.8%。原发胃癌姑息性切除的患者共12例,总体生存时间2～36个月,中位生存时间为13.5个月;未切除原发胃癌的患者共12例,总体生存时间0.5～31个月,中位生存时间为3个月,两组比较P=0.034,差异有统计学意义。结论  胃癌脐转移病理分化程度低,预后差,姑息手术治疗对于部分患者有生存获益,化疗是此类患者的治疗基础。

关键词： 胃癌; 脐转移; 手术; 化疗; 预后

Abstract：

Objective  To analyze the clinical characteristics and treatment experience of umbilical metastasis of gastric cancer and improve the level of clinical diagnosis and treatment. Methods The umbilical metastasis of gastric cancer from January 1994 to January 2019 in the Second People's Hospital of Qinzhou City was analyzed retrospectively. From January 1994 to January 2019, articles on umbilical metastasis of gastric cancer in PubMed, Cinii, CNKI, Wanfang and CQVIP databases were searched, which met the evaluation criteria were enrolled. Clinical data was collected and summarized. Results A total of 18 literatures were included, and a qualified patient in our hospital was also included. The clinical features of 24 cases were summarized. The average age was 57.9±15.6 years old, and the median onset was 11.0 months. The primary symptom included umbilical mass or other related symptoms (58.3%, 14/24). Misdiagnosis as umbilical mass or infection was 16.7% (4/24). The size of umbilical metastatic tumor was 1.2~8 cm, with an average of 2.9±1.5 cm. Meanwhile, 14 patients (58.3%, 14/24) had peritoneal implantation metastasis, 3 patients (12.5%) had liver metastasis, 2 patients (8.3%) had lung metastasis, and 1 patient (4.2%) had hepatic round ligament metastasis. In the pathology of primary gastric cancer, the cases with moderate or low differentiation accounted for 80.0% (16/20), and the cases with low differentiation in umbilical metastasis accounted for 87.5% (7/8). Overall survival time of patients in this group was 0.5-36 months, median survival time was 8.5 months, 1-year survival rate was 57.0%, 2-year survival rate was 34.2%, and 3-year survival rate was 22.8%. Twelve patients underwent palliative resection of primary gastric cancer. The overall survival time was 2-36 months and the median survival time was 13.5 months. The overall survival time of patients with un -resected primary gastric cancer was 0.5 -31 months, with a median survival time of 3 months. The difference between the two groups was statistically significant (P=0.034). Conclusions The pathological differentiation of gastric cancer with umbilical metastasis is low and the prognosis is poor. Palliative surgery has benefits for some patients, and chemotherapy is the basic treatment for such patients.

Key Words:  Gastric cancer; Umbilical metastasis; Surgery; Chemotherapy; Prognosis