Serban D, Branescu C, Savlovschi C, Simion G, Mihai A, El-Khatib A, Tudor C, Nica A, Vancea G, Ghelase M, Dascalu A M
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
IVth Upper Digestive Surgery Clinic, University Emergency Hospital, Bucharest, Romania.
J Med Life. 2016 Jul-Sep;9(3):291-293.
The paper presents the case of a male patient, hospitalized for acute abdomen due to perforated callous ulcer. Though the clinical appearance suggested a benign pathology, the histopathological exam of the resection piece showed multicentric early gastric carcinoma, signet ring cell type. At the patient's request, total gastrectomy was not performed, a conservative solution being chosen instead. Superior digestive endoscopy with biopsy and oncological dispensarization was performed one month after surgery, then at every 6 months. After 2 years of benign results, the histopathological exam revealed the presence of malign singlet ring cells in the bioptic specimen. Respecting the patient's option of preserving a good quality of life, subtotal gastrectomy with Pean type gastroenteroanastomosis was performed followed by postoperatory chemotherapy. Endoscopic and oncological follow-up were performed at every six months for another 3 years (up to present), and the evolution was favorable with no local or metastatic recurrence. Histopathological examination was of great help in the surgical management of this case, allowing a fortunate early diagnosis, a conservative surgical approach, and the preserving of a good quality of life.
本文介绍了一名男性患者的病例，该患者因胼胝性溃疡穿孔导致急腹症而住院。尽管临床表现提示为良性病变，但切除组织的组织病理学检查显示为多中心早期胃癌，印戒细胞型。应患者要求，未进行全胃切除术，而是选择了保守治疗方案。术后1个月进行了上消化道内镜检查及活检和肿瘤专科诊疗，之后每6个月进行一次。在2年的良性结果后，组织病理学检查显示活检标本中存在恶性印戒细胞。考虑到患者保留良好生活质量的选择，进行了Pean式胃肠吻合术的胃次全切除术，随后进行术后化疗。此后每6个月进行一次内镜和肿瘤学随访，持续3年（直至目前），病情进展良好，无局部或转移复发。组织病理学检查对该病例的手术管理有很大帮助，使得能够幸运地早期诊断、采取保守手术方法并保留良好的生活质量。
