Staël von Holstein C, Hammar E, Eriksson S, Huldt B
Department of Surgery, Lund University, Sweden.
Cancer. 1993 Sep 1;72(5):1532-5. doi: 10.1002/1097-0142(19930901)72:5<1532::aid-cncr2820720507>3.0.co;2-8.
Dysplasia often is found in biopsy specimens from the gastric stump some 20 years after ulcer surgery. A high frequency of patients with severe dysplasia in the nonoperated stomach develop carcinoma but the clinical significance of dysplasia in the gastric stump is still confounding.
In the current study, two groups of patients were evaluated. One group of 22 patients, found at the first investigation in an endoscopic screening study with moderate dysplasia in the gastric stump, were regularly followed up to 18 years with endoscopy and biopsies. In the second part of the investigation, the authors evaluated 17 patients from the same endoscopic screening study, who at any instance during the 18 years were found to have severe dysplasia in biopsy specimens from the gastric remnant.
In three of the 22 patients with moderate dysplasia, stump carcinoma was diagnosed 2, 2, and 6 years, respectively, after the first endoscopic examination. Severe dysplasia was found in two other patients at one occasion but later investigations only revealed moderate dysplasia. The remainder of the patients in this group had either persisting moderate dysplasia or mild dysplasia at follow-up. Seven (41%) of the 17 patients with severe dysplasia had stump carcinoma within a median time of 2 years (range, 1-11). Two other patients had surgery based on suspicion of carcinoma, but had only severe dysplasia in the surgical specimen. Finally, three men died (after 1, 2, and 17 years, respectively) of unrelated disease without suspicion of stump carcinoma and five patients were followed between 6 and 18 years without signs of malignant development.
Patients with moderate and, especially, severe dysplasia in the gastric remnant are at high risk for gastric carcinoma. Severe dysplasia calls for endoscopic surveillance at short intervals. For patients with moderate dysplasia a close surveillance for 2 years followed by biannual evaluation appears sufficient.
在溃疡手术约20年后，胃残端活检标本中常发现发育异常。未手术胃中重度发育异常的患者发生癌变的频率较高，但胃残端发育异常的临床意义仍不明确。
在本研究中，对两组患者进行了评估。一组22例患者，在首次内镜筛查研究中发现胃残端有中度发育异常，定期进行内镜检查和活检随访18年。在研究的第二部分，作者评估了同一内镜筛查研究中的17例患者，他们在18年中的任何时候胃残端活检标本中均发现有重度发育异常。
22例中度发育异常患者中，有3例分别在首次内镜检查后2年、2年和6年被诊断为残端癌。另外2例患者曾一度发现有重度发育异常，但后来的检查仅显示为中度发育异常。该组其余患者在随访中要么持续存在中度发育异常，要么为轻度发育异常。17例重度发育异常患者中有7例（41%）在中位时间2年（范围1 - 11年）内发生了残端癌。另外2例患者因怀疑癌变接受手术，但手术标本中仅发现重度发育异常。最后，3例男性患者（分别在1年、2年和17年后）死于无关疾病，未怀疑有残端癌，5例患者随访6至至18年，无恶性进展迹象。
胃残端有中度尤其是重度发育异常的患者患胃癌风险较高。重度发育异常需要短间隔进行内镜监测。对于中度发育异常患者，密切监测2年，随后每半年评估一次似乎就足够了。
