Hashimoto M, Abo S, Kitamura M, Izumi K, Shikama T, Temma K
Second Department of Surgery, Akita University School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Jul;43(7):1016-22.
Two patients are presented who underwent resection of a gastric tube placed in the posterior mediastinum during reconstruction following radical esophageal resection for esophageal cancer. The indications for gastric tube resection were bleeding from a peptic ulcer in one and gastric cancer in the other. Case 1: A 72-year-old man, who had undergone a thoracic esophagectomy 3.5 years prior to admission, presented with a chief complaint of hematemesis. The gastric tube was resected and replaced with an antethoracic, pedicled segment of left colon. Pathologic examination of the resected gastric tube revealed a penetrating peptic ulcer. Case 2: A 65-year-old man with esophageal cancer and early gastric cancer underwent thoracic esophagectomy with combined resection of the fundus and lesser curvature of the stomach. One year later, he was found to have a new early gastric cancer in the antrum. The distal portion of the gastric tube was resected and replaced with a pedicled jejunal graft. Of the 526 patients with esophageal cancer treated in our department from 1972 to 1993, peptic ulcers were evident in the gastric tube used to reconstruct the esophagus in only seven cases. The stomach was resected in only one of these patients. Similar patients requiring gastric tube resection have been reported. All six of these cases are reviewed. Cancer of the gastric tube developed in 3 of the 526 patients. Although 74 cases of gastric tube cancer have been reported in the Japanese literature, the patient presented here (case 2) is the first to undergo successful resection of the stomach from the posterior mediastinal position.
本文介绍了两名患者，他们在因食管癌行根治性食管切除术后重建过程中，接受了位于后纵隔的胃管切除术。胃管切除的指征，一例为消化性溃疡出血，另一例为胃癌。病例1：一名72岁男性，入院前3.5年接受了胸段食管切除术，主诉为呕血。切除胃管后，用带蒂的左结肠胸段进行替代。切除的胃管病理检查显示为穿透性消化性溃疡。病例2：一名患有食管癌和早期胃癌的65岁男性，接受了胸段食管切除术，并联合切除胃底和胃小弯。一年后，发现其胃窦部出现新的早期胃癌。切除胃管远端，并用带蒂空肠移植进行替代。在1972年至1993年期间，在我院接受治疗的526例食管癌患者中，仅7例用于重建食管的胃管出现了消化性溃疡。这些患者中只有1例切除了胃。已有报道类似需要切除胃管的患者。对所有这6例病例进行了回顾。526例患者中有3例发生了胃管癌。虽然日本文献中已报道了74例胃管癌病例，但本文介绍的患者（病例2）是首例成功从后纵隔位置切除胃的患者。
