McDermott M, Hourihane D O
Department of Pathology, St James' Hospital, Dublin, Ireland.
J Clin Pathol. 1993 May;46(5):483-5. doi: 10.1136/jcp.46.5.483.
The clinical, histological, and necropsy findings of three cases of fatal, nonmalignant ulceration in the gastric tube after oesophageal resection for oesophageal malignancy are presented. The deaths occurred three, 30, and 42 months, respectively, after initial surgery. Two of the patients had received chemoradiotherapy, one at initial presentation, and one for a recurrence 18 months after surgery. In two patients death was due to an aspiration pneumonia, consequent on the development of a gastrobronchial fistula. The third patient died after a massive haematemesis. In none of the cases was there any evidence of residual or recurrent malignancy at necropsy, although in the two cases where radiological and endoscopic assessment was performed before death, recurrent tumour had been clinically diagnosed. As improved surgical techniques reduce the incidence of death due to anastomotic leakage and combined modality treatment regimens offer improved prospects of tumour remission, deaths from other causes will assume a greater importance. As such, the possibility that ulceration in the gastric tube may be due to causes other than tumour recurrence deserves greater recognition.
本文报告了3例因食管恶性肿瘤行食管切除术后胃管发生致命性非恶性溃疡的临床、组织学及尸检结果。死亡分别发生在初次手术后3个月、30个月和42个月。其中2例患者接受了放化疗，1例在初次就诊时接受，另1例在术后18个月复发时接受。2例患者死于吸入性肺炎，这是由胃支气管瘘发展所致。第3例患者死于大量呕血。尸检时，所有病例均未发现残留或复发性恶性肿瘤的证据，尽管在2例死亡前进行了放射学和内镜评估的病例中，临床上已诊断为肿瘤复发。随着手术技术的改进降低了吻合口漏导致的死亡率，联合治疗方案提高了肿瘤缓解的前景，其他原因导致的死亡将变得更加重要。因此，胃管溃疡可能由肿瘤复发以外的原因引起，这一可能性值得更多关注。
