Voigtsberger P, Scheler H, Abe K
Klinik und Poliklinik für Chirurgie, Medizinischen Akademie Erfurt.
Zentralbl Chir. 1987;112(19):1198-207.
The incidence of pathological changes in the wake of stomach surgery amounted to 483 of 550 patients who were endoscopically examined at the Outpatient Department of Surgery attached to the Medical Academy of Erfurt, between January 1st, 1975 and December 31st, 1985. These were 87.8 per cent. Similar findings were recorded from 67 vagotomised patients (12.2 per cent). These 550 cases represented 6.7 per cent of 8,155 patients whose upper digestive tract had been endoscopically examined throughout the above period of time. The first endoscopic check was applied to 49.9 per cent only five or more years, following surgery and to 44.8 per cent within two years from surgery. Pain was recorded as the major symptom and indication for the follow-up checks from 75 per cent of these patients. Pathological changes were endoscopico-macroscopically detectable from 75 per cent of the probands. Ulcers were observed in 20 per cent. Inflammatory changes accounted for 40 per cent in both groups. Tumours were established in ten per cent. Macroscopic findings were histologically verified in 208 cases (37.8 per cent), among them 41.2 per cent after stomach resection and 13.2 per cent following vagotomy. Suspicious diagnoses of inflammation was thus positively verified in 93.4 per cent of all cases and those of malignant tumours in 39 of 47 cases. Inflammatory processes were histologically detected in 31 cases in which it had been neither assumed nor formulated. In eight histologically established tumour cases that diagnosis had not been macroscopically made (inflammations in seven cases and no contributory findings in one). Macroscopic findings recorded from the above selected group of patients proved to be reliable for tumours in 85 per cent of all cases and for gastritis in 93 per cent. Endoscopic follow-up diagnosis should begin within the first year from stomach surgery and should be persistently continued on the basis of a systematic extended medical care programme. All the above findings were gained on the basis of high-continuity computer-adjusted data collection and evaluation.
1975年1月1日至1985年12月31日期间，在爱尔福特医学院附属外科门诊部接受内镜检查的550例胃手术患者中，病理改变的发生率为483例，占87.8%。67例迷走神经切断术患者也有类似发现（占12.2%）。这550例病例占同期8155例接受上消化道内镜检查患者的6.7%。首次内镜检查仅在术后五年或更长时间进行的占49.9%，在术后两年内进行的占44.8%。75%的患者将疼痛作为随访检查的主要症状和指征。75%的受检者内镜宏观检查可发现病理改变。观察到溃疡的占20%。两组中炎症改变均占40%。肿瘤确诊率为10%。208例（占37.8%）的宏观检查结果经组织学证实，其中胃切除术后经组织学证实的占41.2%，迷走神经切断术后占13.2%。因此，所有病例中93.4%的炎症疑似诊断得到了肯定证实，47例恶性肿瘤病例中有39例得到肯定证实。在31例组织学检测到炎症过程的病例中，术前既未推测也未确诊。在8例经组织学确诊为肿瘤的病例中，宏观检查未作出该诊断（7例为炎症，1例无相关发现）。上述选定患者群体的宏观检查结果在所有病例中对肿瘤诊断的可靠性为85%，对胃炎诊断的可靠性为93%。内镜随访诊断应在胃手术后第一年内开始，并应在系统的长期医疗护理计划基础上持续进行。上述所有发现均基于高连续性计算机调整的数据收集和评估。
