Shinohara Toshihiko, Kashiwagi Hideyuki, Nakada Koji, Nimura Hiroshi, Mitsumori Norio, Ohmura Yuichi, Yanaga Katsuhiko
Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
Hepatogastroenterology. 2007 Sep;54(78):1902-4.
We report two patients with suture line recurrence in the jejunal pouch after curative proximal gastrectomy for gastric cancer. The first patient was a 60-year-old asymptomatic woman with gastric cancer (T2N0M0) after curative proximal gastrectomy with jejunal pouch interposition. She had to undergo a second resection for suture line recurrence in the jejunal pouch 12 months later. On examination of the resected specimen, histological examination revealed a moderately differentiated adenocarcinoma, which was similar to that of the primary tumor. The second patient was a 74-year-old man who was also diagnosed as having locoregional recurrences in the jejunal pouch after a curative proximal gastrectomy with an S-shaped pouch for gastric cancer (T2N0M0). Histological examination of the resected specimen revealed moderately differentiated adenocarcinoma, which had a similar histopathology to that of the primary tumor. During the first procedure, the jejunal pouch was formed using several disposable devices and the end-to-side esophagojejunostomy was performed with another circular stapler to avoid contamination through surgical instruments. Exfoliated cancer cells that may have detached from the primary tumor during the surgical procedures could have contributed to local recurrence along the longitudinal suture line of the pouch.
我们报告了两例胃癌根治性近端胃切除术后空肠袋缝线处复发的患者。第一例患者是一名60岁无症状女性，因胃癌（T2N0M0）接受了近端胃切除并空肠袋间置术。12个月后，她因空肠袋缝线处复发不得不接受二次切除。对切除标本进行检查时，组织学检查显示为中分化腺癌，与原发肿瘤相似。第二例患者是一名74岁男性，他在因胃癌（T2N0M0）接受近端胃切除并S形空肠袋重建术后，也被诊断为空肠袋局部复发。切除标本的组织学检查显示为中分化腺癌，其组织病理学与原发肿瘤相似。在第一次手术过程中，使用了多个一次性器械构建空肠袋，并用另一个圆形吻合器进行端侧食管空肠吻合术，以避免手术器械造成污染。手术过程中可能从原发肿瘤脱落的脱落癌细胞可能导致了沿空肠袋纵行缝线处的局部复发。
