Shimada Yutaka, Okumura Tomoyuki, Hojo Shozo, Matsui Koshi, Nagata Takuya, Hayashi Shinichi, Tazawa Kenichi, Yamagishi Fuminori, Tsukada Kazuhiro
Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Sugitani 2630, Toyama, Japan Department of Nanobaio Drug Discovery, Graduate school of Pharmaceutical Sciences, Kyoto University. Yoshida Shimoadachi-cho, 46-29, Sakyo-ku, Kyoto, Japan.
Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Sugitani 2630, Toyama, Japan.
J Surg Case Rep. 2013 Dec 4;2013(12):rjt100. doi: 10.1093/jscr/rjt100.
Although Barrett's esophagus may occur without gastric acid, Barrett's adenocarcinoma after total gastrectomy is rare. Here, we present Barrett's adenocarcinoma in long-segment Barrett's esophagus after total gastrectomy. The patient was a 74-year-old male who underwent total gastrectomy 44 years ago. An endoscopic examination revealed long-segment Barrett's esophagus starting 17 cm from the incisors and continuing 20 cm to esophagojejunostomy, with irregular mucosa 27-31 cm from the incisors. Pathological diagnosis of a biopsied specimen was adenocarcinoma. We performed subtotal esophagectomy with lymph node dissection in the prone position and reconstructed the esophagus with ileocolic interposition. Postoperative pathological diagnosis from a Barrett's epithelial section was well differentiated adenocarcinoma. This case had the longest interval from total gastrectomy and smallest oral margin of Barrett's epithelium. Our case suggested that careful surveillance is needed for patients exhibiting recurrent bile reflux following total gastrectomy.
尽管巴雷特食管可能在无胃酸的情况下发生，但全胃切除术后的巴雷特腺癌却很罕见。在此，我们报告一例全胃切除术后长段巴雷特食管并发巴雷特腺癌的病例。该患者为一名74岁男性，44年前接受了全胃切除术。内镜检查发现长段巴雷特食管，起自距门齿17 cm处，延续至食管空肠吻合口20 cm，在距门齿27 - 31 cm处黏膜不规则。活检标本的病理诊断为腺癌。我们在俯卧位下行次全食管切除术并清扫淋巴结，采用回结肠间置术重建食管。巴雷特上皮切片的术后病理诊断为高分化腺癌。该病例是全胃切除术后间隔时间最长且巴雷特上皮切缘最小的病例。我们的病例提示，对于全胃切除术后出现胆汁反流复发的患者需要进行密切监测。
