Tersmette A C, Giardiello F M, Tytgat G N, Offerhaus G J
Dept. of Pathology, Academic Medical Center, Amsterdam, The Netherlands.
Scand J Gastroenterol Suppl. 1995;212:96-9. doi: 10.3109/00365529509090306.
Remote partial gastrectomy for benign disease is a premalignant condition. The overall risk of gastric stump cancer is approximately a twofold increase, but patients more than 20-25 years postoperatively may have a four- to fivefold increased risk, compared to the age- and sex-matched general population. The duration of postoperative interval is the most important risk factor. For the first 10 years after initial surgery, gastric cancer risk may be reduced due to the removal of the most cancer-prone distal part of the stomach, but thereafter there is a rapid increase of the relative risk. The etiology and precise mechanism of carcinogenesis is unknown, but the time relationship with surgery suggests that the anatomical alterations induced by the operation must be important. Hypochlorhydria, reflux, diminished gastrin production, bacterial proliferation, and nitrosation are the putative contributing factors. In addition, smoking appears to contribute to a generalized cancer mortality and decreased life expectancy after peptic ulcer surgery. Digestive tract cancers other than the gastric ones which show an increased risk after peptic ulcer surgery are pancreatic and biliary tract cancers. Premalignant and precursor lesions occur more frequently in the gastric remnant after peptic ulcer surgery and endoscopic bioptic screening can detect early stump cancers at a curable stage. Large-scale screening programs of post-gastrectomy patients are nevertheless not recommended, and surveillance appears not justified.
良性疾病的远端部分胃切除术是一种癌前状态。胃残端癌的总体风险大约增加两倍，但与年龄和性别匹配的普通人群相比，术后20 - 25年以上的患者风险可能增加四到五倍。术后间隔时间是最重要的风险因素。在初次手术后的前10年，由于切除了最易患癌的胃远端部分，胃癌风险可能降低，但此后相对风险会迅速增加。致癌的病因和确切机制尚不清楚，但与手术的时间关系表明手术引起的解剖学改变一定很重要。胃酸过少、反流、胃泌素分泌减少、细菌增殖和亚硝化是假定的促成因素。此外，吸烟似乎会导致消化性溃疡手术后总体癌症死亡率上升和预期寿命缩短。消化性溃疡手术后风险增加的非胃癌性消化道癌症是胰腺癌和胆管癌。癌前病变和前驱病变在消化性溃疡手术后的胃残端中更频繁出现，内镜活检筛查可以在可治愈阶段检测出早期残端癌。然而，不建议对胃切除术后患者进行大规模筛查，而且监测似乎也不合理。
