空肠空肠吻合口转位成功治疗全胃切除术后严重反流性食管炎：两例报告

Severe reflux esophagitis after total gastrectomy successfully treated by transposition of the jejunojejunal anastomosis: a report of two cases.

作者信息

Nishiwaki Noriyuki, Hato Shinji, Kagawa Tetsuya, Kakishita Tomokazu, Nozaki Isao

机构信息

Department of Surgery, National Hospital Organization, Shikoku Cancer Center, 160, Ko, Minamiumemoto-machi, Matsuyama-shi, Ehime-Ken, 791-0280, Japan.

Department of Gastroenterological Surgery, Fukuyama City Hospital, 5-23-1, Zao-cho, Fukuyama City, Hiroshima Prefecture, 721-8511, Japan.

出版信息

Surg Case Rep. 2021 Dec 20;7(1):270. doi: 10.1186/s40792-021-01350-0.

DOI:10.1186/s40792-021-01350-0

PMID:34928458

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8688638/

Abstract

BACKGROUND

Reflux esophagitis after total gastrectomy is often difficult to treat. In this report, we describe two cases of reflux esophagitis that were refractory to medical therapy and successfully treated by transposition of the jejunojejunal anastomosis.

CASE PRESENTATION

Case 1: A 66-year-old man underwent total gastrectomy and cholecystectomy for gastric cancer, and Roux-en-Y (RY) reconstruction was performed. The pathological diagnosis was T4aN3aM0 stage IIIC. Five months later, esophagogastroduodenoscopy identified reflux esophagitis. Although he was treated with various oral medications and was hospitalized six times, he lost 19 kg of weight. Finally, the patient was reoperated 3 years postoperatively. Intraoperative findings showed that there was no evidence of recurrence or severe adhesions that could have caused obstruction, and the anastomotic distance between the esophagojejunostomy and the jejunojejunostomy was approximately 40 cm. The jejunojejunostomy was re-anastomosed to increase the distance to 100 cm. Two years and 6 months after the reoperation, there was no recurrence of reflux esophagitis, and the patient's weight increased by 14 kg. Case 2: A 68-year-old woman underwent total gastrectomy and cholecystectomy for gastric cancer, and RY reconstruction was performed. The pathological diagnosis was T4aN0M0 stage IIB. Similar to Case 1, the patient was diagnosed with reflux esophagitis 5 months later. She lost 23 kg of weight and was reoperated at 6 months postoperatively. Intraoperative findings showed that there was no evidence of recurrence or severe adhesions, and transposition of the jejunojejunostomy was performed to increase the distance between anastomoses from 40 to 100 cm. Two years and 8 months after the reoperation, there was no recurrence of reflux esophagitis, and her weight increased by 15 kg.

CONCLUSIONS

Transposition of the jejunojejunostomy was an effective treatment for medication-resistant severe reflux esophagitis after total gastrectomy.

摘要

背景

全胃切除术后反流性食管炎常难以治疗。在本报告中，我们描述了两例药物治疗无效的反流性食管炎患者，通过空肠空肠吻合术转位成功治愈。

病例介绍

病例1：一名66岁男性因胃癌接受了全胃切除术和胆囊切除术，并进行了Roux-en-Y（RY）重建。病理诊断为IIIC期T4aN3aM0。五个月后，食管胃十二指肠镜检查发现反流性食管炎。尽管他接受了各种口服药物治疗并住院六次，但体重减轻了19公斤。最终，患者在术后3年再次手术。术中发现无复发迹象或严重粘连导致梗阻，食管空肠吻合口与空肠空肠吻合口之间的吻合距离约为40厘米。将空肠空肠吻合口重新吻合，使距离增加到100厘米。再次手术后两年零六个月，反流性食管炎未复发，患者体重增加了14公斤。病例2：一名68岁女性因胃癌接受了全胃切除术和胆囊切除术，并进行了RY重建。病理诊断为IIB期T4aN0M0。与病例1相似，患者在五个月后被诊断为反流性食管炎。她体重减轻了23公斤，并在术后6个月再次手术。术中发现无复发迹象或严重粘连，进行了空肠空肠吻合术转位，使吻合口之间的距离从40厘米增加到100厘米。再次手术后两年零八个月，反流性食管炎未复发，她的体重增加了15公斤。