Zlatić Aleksandar, Stojanović Miroslav, Mihailović Dragan, Dinić Biljana Radovanović, Protić Mladan, Veljković Radovan
Clinical Centre Nis, General Surgery Clinic, University of Nis, Medical Faculty.
Med Pregl. 2013 Jul-Aug;66(7-8):285-91. doi: 10.2298/mpns1308285z.
Duodenogastric reflux, commonly encountered as an aftermath of gastroenteroanastomosis, with or without gastric resection (Billroth I, Billroth II), vagotomy and pyloroplastic surgery, is known to cause inflammatory-dystrophic-metaplastic lesions of gastric mucosa. Our objective was to determine the effects of surgery-induced duodenogastric reflux on the development of precarcinogenic lesions or carcinoma in correlation with the reflux duration.
The experiment was performed on three groups of Wistar rats with 1) Billroth II-induced reflux surgery, 2) resection of the Rouxr-en-Y type reconstruction, and 3) control group with no resection. The aim of the experiment was to study the effects ofduodenogastric reflux on the rat gastric mucosa in correlation with two different types of gastroenteroanastomosis 8, 16 and 24 weeks after the surgery.
In Billroth II group, hyperplastic changes were observed as early as in week 16. Statistically significant results were recorded in week 24, with 6.7% of metaplastic alterations, including dysplasia of all three degrees, dominantly severe dysplasia in 66.67%, early carcinoma in 20% and gastric carcinoma in 6.67%. In the Roux-en-Y group, gastric mucosa remained predominantly normal (60%), with somewhat increased frequency ofgastritis and dysplasia in week 24. In the control group, the finding of normal gastric mucosa was constant.
The experiment confirms that direct contact of duodenal juice with gastric mucosa associated with Billroth II resection causes precarcinogenic lesions. Development of adenocarcinoma caused solely by duodenogastric reflux, excluding a carcinogenic agent is possible 20 weeks after the experiment--earlier than suggested by previous researchers.
十二指肠-胃反流常见于胃肠吻合术后，无论有无胃切除术（毕罗一世式、毕罗二世式）、迷走神经切断术和幽门成形术，已知其会导致胃黏膜的炎性-营养不良-化生病变。我们的目的是确定手术引起的十二指肠-胃反流对癌前病变或癌症发展的影响，并与反流持续时间相关联。
对三组Wistar大鼠进行实验，1）毕罗二世式诱导反流手术组，2）Roux-en-Y型重建切除术组，3）未切除的对照组。实验目的是研究术后8周、16周和24周时，两种不同类型的胃肠吻合术相关的十二指肠-胃反流对大鼠胃黏膜的影响。
在毕罗二世式组中，早在第16周就观察到增生性变化。在第24周记录到具有统计学意义的结果，有6.7%的化生改变，包括所有三级发育异常，其中66.67%为重度发育异常，20%为早期癌，6.67%为胃癌。在Roux-en-Y组中，胃黏膜主要保持正常（60%），在第24周时胃炎和发育异常的发生率略有增加。在对照组中，胃黏膜正常的发现是持续的。
实验证实，毕罗二世式切除术后十二指肠液与胃黏膜的直接接触会导致癌前病变。仅由十二指肠-胃反流引起腺癌的发生，排除致癌因素，在实验20周后是可能的——比先前研究人员提出的时间更早。
