Hanashi T, Ide H, Nogami A, Hanyu F, Yamada A, Nozaki M
Institute of Gastroenterology, Tokyo Women's Medical College, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1991 Aug;39(8):1242-6.
The development of peptic ulcers in gastric tubes used for esophageal reconstruction for cancer are rare. However, they can potentially cause serious complications, including perforation and hemorrhaging. We experienced a case in which an ulcer of large size developed in the gastric tube, and it was very difficult to treat. The patient was a 72-year-old man, who had undergone an esophagotomy of the thoracic portion, an gastroesophagoplasty through the anterior portion of the sternum, and postoperative radiotherapy 2 years ago. Eight days after his admission, the ulcer began excessive bleeding, and we performed an emergency operation. The ulcer perforated into the mediastinum, and developed an abscess involving the intrathoracic artery. After hemostasis and debridement, we resected the upper half of the gastric tube, closed the oral side of the remaining portion, and converted the cervical esophageal stump into an external fistula. The wound was covered with a flap. A histological examination showed an ulcer with no evidence of malignancy, and without any signs of healing. Five months were required for the wound to heal completely. After that, we succeeded in reconstruction through jejunal free-transfer, using the microvascular surgery technique. Some pathogenesis is suggested for gastric ulcers after gastroesophagoplasty. Despite performing a vagotomy, the secretion of acid from the gastric mucosa is common. Both this condition, and the deterioration of the mucosal barrier caused by surgery, can play significant roles in the development of the ulcer. The histological influence of postoperative radiotherapy is also important, as this treatment aggravates the circulatory disturbance, and disturbs the histological reaction necessary for healing.
用于食管癌重建的胃管发生消化性溃疡的情况罕见。然而，它们可能会引发严重并发症，包括穿孔和出血。我们遇到过一例胃管内出现大尺寸溃疡且极难治疗的病例。患者为一名72岁男性，两年前接受了胸段食管切开术、经胸骨前部的胃食管成形术及术后放疗。入院八天后，溃疡开始大量出血，我们进行了急诊手术。溃疡穿孔进入纵隔，并形成了累及胸内动脉的脓肿。止血和清创后，我们切除了胃管的上半部分，封闭了剩余部分的开口端，并将颈段食管残端改为外瘘。伤口用皮瓣覆盖。组织学检查显示为无恶性证据且无愈合迹象的溃疡。伤口完全愈合需要五个月时间。之后，我们通过微血管手术技术成功地进行了空肠游离移植重建。胃食管成形术后胃溃疡的发病机制有多种推测。尽管进行了迷走神经切断术，但胃黏膜仍常见胃酸分泌。这种情况以及手术导致的黏膜屏障破坏，在溃疡形成过程中都可能起重要作用。术后放疗的组织学影响也很重要，因为这种治疗会加重循环障碍，并干扰愈合所需的组织学反应。
