Takemura M, Higashino M, Osugi H, Tokuhara T, Fujiwara K, Kinoshita H
Second Department of Surgery, Osaka City University Medical School, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Dec;45(12):1992-7.
The peptic ulcer of gastric tube using for esophageal reconstruction is rare. We report herein five cases of peptic ulcer of gastric tube used for esophageal reconstruction after esophagectomy for esophageal carcinoma. The reconstructive route, in all cases, was posterior mediastinum. In one case, 10 days after esophagectomy, he had high grade fever and pneumonia of right lower lobe of lung. Endoscopic examination revealed a deep ulcerative lesion on anterior wall of gastric tube and fistula formation on membranous part of trachea. The partial resection of gastric tube was performed for closing to tracheo-gastro fistula. In other four cases, the location of ulcer was middle or lower third of gastric tube. One had multiple peptic ulcer and other had single. Two cases of four underwent post irradiation therapy. One case of then, the Helicobacter infection detected using by rapid urease test and histological examination. We analyzed of Helicobacter pylori infection and serum gastrin level of gastric tube in outpatients who have used gastric tube for esophageal reconstruction after radical esophagectomy. Helicobacter pylori infection was positive at 56% (9/16) of all patients. The serum gastrin level of patients who was positive of Helicobacter pylori infection is not significantly higher than that of patients who was negative. We consider that post operative irradiation therapy and Helicobacter infection might play in development of peptic ulcer of gastric tube.
用于食管重建的胃管发生消化性溃疡较为罕见。本文报告5例食管癌切除术后用于食管重建的胃管发生消化性溃疡的病例。所有病例的重建路径均为后纵隔。1例患者在食管癌切除术后10天出现高热及右下肺肺炎。内镜检查发现胃管前壁有深溃疡病变，气管膜部形成瘘管。为闭合气管-胃瘘，对胃管进行了部分切除。其他4例溃疡位于胃管中下段。1例有多发消化性溃疡，另1例为单发。4例中有2例接受了放疗。其中1例通过快速尿素酶试验和组织学检查检测到幽门螺杆菌感染。我们分析了根治性食管切除术后使用胃管进行食管重建的门诊患者胃管的幽门螺杆菌感染情况和血清胃泌素水平。所有患者中幽门螺杆菌感染阳性率为56%（9/16）。幽门螺杆菌感染阳性患者的血清胃泌素水平并不显著高于阴性患者。我们认为术后放疗和幽门螺杆菌感染可能在胃管消化性溃疡的发生中起作用。
