Suzuki S, Matsushima S, Hirai K, Yamamoto H, Shibuya T, Shoji T
Second Department of Surgery, Nippon Medical School, Tokyo, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Aug;41(8):1399-404.
We encountered a case of simultaneous association of an intraepithelial esophageal carcinoma and an intramucosal gastric carcinoma with radical operation. Up to present, only four cases including this report had been printed in Japan. A 67-year-old with chronic cholecystitis was pointed out the esophageal lesion (O-IIa) in the Im area by FGS after it had demonstrated the gastric lesion (early I) at the posterior wall of the prepyrolus. We performed subtotal esophagectomy, total gastrectomy, pyroloplasty with esophagoileostomy through the retrosternal tunnel and lymph nodes dissection (R2). On gross inspection, there was no obvious lesion in the esophagus. Microscopic examination revealed no invasion of cancerous cells to lymph nodes, lymph ducts, and vessels. The patient followed post operative respiratory disorders which not lung edema but atelectasis caused because perioperative measurement of Extra Vascular Lung Water Index (EVLWI) was stable within normal values.
我们遇到了一例同时合并上皮内食管癌和黏膜内胃癌并接受根治性手术的病例。截至目前，包括本报告在内，日本仅发表了4例。一名患有慢性胆囊炎的67岁患者，在经荧光内镜检查（FGS）发现胃窦后壁有胃病变（早期I型）后，又发现了食管下段（Im区）的病变（O-IIa型）。我们进行了次全食管切除术、全胃切除术、经胸骨后隧道行食管空肠吻合术及胃成形术，并进行了淋巴结清扫（R2）。大体检查时，食管未见明显病变。显微镜检查显示癌细胞未侵犯淋巴结、淋巴管和血管。患者术后出现呼吸功能障碍，并非肺水肿，而是肺不张，因为围手术期血管外肺水指数（EVLWI）的测量值在正常范围内保持稳定。
