Pointner R, Schwab G, Königsrainer A, Bodner E, Schmid K W
1st Department of Surgery, University of Innsbruck, Austria.
Endoscopy. 1989 May;21(3):115-9. doi: 10.1055/s-2007-1012917.
Between 1959 and 1987, at the Innsbruck University Hospital, 359 cases of carcinoma were diagnosed in the gastric remnant. While until 1975 in 203 patients suffering from stump carcinoma the tumor stages T3 and T4 were significantly prevalent, a strong tendency towards the less advanced tumor stages T1 and T2 was observed in the last decade. Among 94 patients operated on since 1981 the tumor was located at the anastomosis in all but 5 cases, suggesting a strong connection between previous resection and stump carcinoma. In accordance with Lauren's classification no difference was found in the incidence of intestinal and diffuse lesions in 94 cases with stump carcinoma--in contrast to 69 cases of patients with a non-resected stomach. An analysis of the occurrence of acidity, atrophic gastritis and bacterial invasion in 70 patients with previous Billroth II resection and 30 patients with Billroth I resection, revealed no difference between the two types of resection. Gastric remnant carcinoma does not occur exclusively in the Bilroth II remnant, but, increasingly, following Billroth I operations. The finding of a statistically highly significant increase at the 5% level using standard chi 2-technique for a 2 x 5 table in stump carcinomas following Billroth I resections supports the thesis that there is no difference in the etiopathology of carcinogenesis in the Billroth I as compared with the Billroth II remnant.
1959年至1987年间，在因斯布鲁克大学医院，共诊断出359例残胃癌。直到1975年，203例残胃癌患者中，肿瘤分期为T3和T4的情况显著多见，但在过去十年中，观察到肿瘤分期向较早期的T1和T2发展的强烈趋势。自1981年以来接受手术的94例患者中，除5例之外，肿瘤均位于吻合口处，这表明既往切除术与残胃癌之间存在紧密联系。根据劳伦分类法，94例残胃癌患者中肠型和弥漫型病变的发生率没有差异，这与69例未行胃切除的患者情况相反。对70例既往接受毕罗Ⅱ式切除术的患者和30例接受毕罗Ⅰ式切除术的患者的胃酸分泌、萎缩性胃炎和细菌感染情况进行分析，结果显示两种切除术之间没有差异。残胃癌并非仅发生于毕罗Ⅱ式残胃，在毕罗Ⅰ式手术后也越来越常见。使用标准卡方技术对2×5表格进行分析，结果显示毕罗Ⅰ式切除术后残胃癌在5%水平上有统计学高度显著增加，这支持了以下论点：与毕罗Ⅱ式残胃相比，毕罗Ⅰ式残胃在致癌病因学方面没有差异。
