Bajtai A, Figus I A, Kiss J, Szántó I
Orv Hetil. 1989 May 21;130(21):1087-91.
In a series of 160 patients submitted to esophageal resection because of cancer, four cases were found who have been partially gastrectomized for benign stomach or duodenal ulcer decades ago (2.5%). An other similar case was detected by endoscopy and aimed biopsy. In the sixth patient, the cancer developed simultaneously in the gastric remnant and in the distal jejunum loop after partial gastrectomy of Billroth--II. type. Two esophageal cancers of the above-mentioned four resected specimens, were in the T1 stage according to TNM classification of UICC. One tumour of the later two esophageal carcinomas did not reveal any clinical sign. The patient had at the same time early invasive cancer in the gallbladder and synchronously a renal cell carcinoma in the left kidney. The main clinical symptoms of the last patient could be attributed to the gallstone disease. The esophageal carcinomas that developed after partial gastrectomy did not show any difference neither in localization, in the macro- or in the microscopical features nor in the chronic esophagitis and epithelial dysplasia in comparison with other esophageal cancer of patients who were not submitted to partial gastrectomy. Attention must be called to the significance of reflux-esophagitis which can occur with partial gastrectomy. The follow-up of such patients is doubly important if the forceps biopsy detected epithelial dysplasia in the esophagus. On the other hand, the reconstruction of HIS-angle during partial gastrectomy is very important in the prevention of reflux-esophagitis.
在一系列因癌症接受食管切除术的160例患者中,发现有4例患者数十年前因良性胃或十二指肠溃疡接受过部分胃切除术(2.5%)。通过内镜检查和靶向活检又发现了1例类似病例。在第6例患者中,毕Ⅱ式部分胃切除术后,残胃和空肠袢远端同时发生了癌症。根据国际抗癌联盟(UICC)的TNM分类,上述4例切除标本中的2例食管癌处于T1期。后2例食管癌中的1例肿瘤未表现出任何临床症状。该患者同时患有胆囊早期浸润性癌和左肾同步肾细胞癌。最后1例患者的主要临床症状可归因于胆结石病。与未接受部分胃切除术患者的其他食管癌相比,部分胃切除术后发生的食管癌在定位、大体或微观特征以及慢性食管炎和上皮发育异常方面均未显示出任何差异。必须注意部分胃切除术后可能发生的反流性食管炎的重要性。如果钳取活检在食管中检测到上皮发育异常,对这类患者的随访就显得尤为重要。另一方面,部分胃切除术中重建His角对于预防反流性食管炎非常重要。