Koide N, Hiraguri M, Nishio A, Hanazaki K, Adachi W, Shikama N, Oguchi M, Maezawa T, Amano J
Second Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
J Gastroenterol Hepatol. 2001 Feb;16(2):137-41. doi: 10.1046/j.1440-1746.2001.02415.x.
Ulcer in the gastric tube for esophageal replacement, which was caused by peptic factors or postoperative radiotherapy (Rx), are occasionally reported. The aim of this study was to clarify the clinicopathologic features of the ulcers in the gastric tube.
In 62 patients with a reconstructed gastric tube, after esophagectomy for esophageal cancer, esophagogastroduodenoscopy was performed. Ulcers of the gastric tube were detected in 12 patients: six with postoperative Rx and six without Rx. The 12 patients with gastric tube ulcers (GU-group) were reviewed and compared to the remaining 50 patients without ulcers of the gastric tube (Control-group). Clinicopathologic features of gastric tube ulcers were compared between the patients with and without Rx.
There was no difference in any parameter between the patients of the GU- and Control-groups. Comparing the patients of the GU-group with and without Rx, the ulcers of the gastric tube in the patients without Rx were frequently located in the lower part of the gastric tube (P = 0.067), detected in a later period after surgery (P = 0.055), associated with cervical esophagitis (P = 0.03), and less associated with gastritis (P = 0.03). In three patients of the GU-group without Rx, Helicobacter pylori was detected in the gastric tube. Two of the three patients had a history of peptic ulcers before surgery, and had recurrence of the gastric tube ulcers.
Gastric tube ulcers without postoperative Rx may have different characteristics compared to those induced by Rx.
食管置换术中胃管溃疡偶有报道，其病因包括消化因素或术后放疗（Rx）。本研究旨在阐明胃管溃疡的临床病理特征。
62例食管癌切除术后行胃管重建的患者接受了食管胃十二指肠镜检查。12例患者发现胃管溃疡：6例有术后放疗史，6例无放疗史。对12例胃管溃疡患者（GU组）进行回顾性分析，并与其余50例无胃管溃疡的患者（对照组）进行比较。比较有和无放疗史的胃管溃疡患者的临床病理特征。
GU组和对照组患者的任何参数均无差异。比较有和无放疗史的GU组患者，无放疗史患者的胃管溃疡常位于胃管下部（P = 0.067），在术后较晚时期发现（P = 0.055），与颈段食管炎相关（P = 0.03），与胃炎的相关性较小（P = 0.03）。在无放疗史的GU组3例患者中，胃管内检测到幽门螺杆菌。这3例患者中有2例术前有消化性溃疡病史，且胃管溃疡复发。
与放疗引起的胃管溃疡相比，无术后放疗的胃管溃疡可能具有不同的特征。
