Giuliani A, Spada S, Littera A M, De Ligio F, De Ligio S, Galasso V, Schiffino L, Del Ben M
I Istituto di Clinica Chirurgica, Università degli Studi di Roma La Sapienza.
Ann Ital Chir. 1998 Mar-Apr;69(2):169-75; discussion 175-7.
The gastric remnant can be regarded as a model to investigate the events of gastric carcinogenesis of intestinal type. Histologic changes precursor of the malignancy develop in higher incidence in the postoperative stomachs than in non-resected ones. 316 patients hemi-gastrectomized for peptic ulcer were assessed by an endoscopic-histologic study to provide further informations on the sequential chain of histologic lesions that precede the development of cancer. The anastomosis was by far the commonest diseased area at endoscopy, particularly in the patients with a Billroth II resection (p < 0.0004). The 10% of the 233 patients biopsied evidenced a normal gastric mucosa, in the others Superficial Gastritis 74%, Chronic Atrophic Gastritis 36%, Cystic Dilatation 52%, Foveolar Hyperplasia 29%, Intestinal Metaplasia 39%, moderate-severe Dysplasia 6% as single abnormality or variously associated were observed. The stoma was the most damaged area at histology. The occurrence of the DC, the FI and the IM at the anastomotic site was significative (p values between 0.02 and 0.001). The earliest postoperative histologic lesion was the CAG, evidenced, in mean 13 years after operation, the latest the DC observed in mean 18 years after surgery (p < 0.004). The IM, the IF, the CD, and the dysplasia in association with the CAG were observed at postoperative intervals shorter when non-associated with CAG (respective p value: NS, < 0.03, < 0.0002, NS). The probability of transition from an histologic lesions to a more advanced one in our patients was similar to that of a non resected population at medium--high risk of gastric cancer.
胃残余部分可被视为研究肠型胃癌发生过程的模型。恶性肿瘤的组织学变化前驱病变在术后胃中的发生率高于未切除的胃。对316例因消化性溃疡行半胃切除术的患者进行了内镜组织学研究，以进一步了解癌症发生前组织学病变的连续过程。在内镜检查中，吻合口是最常见的病变区域，尤其是在毕Ⅱ式切除的患者中（p < 0.0004）。在233例接受活检的患者中，10%的患者胃黏膜正常，其他患者中，浅表性胃炎占74%，慢性萎缩性胃炎占36%，囊性扩张占52%，小凹增生占29%，肠化生占39%，中度至重度发育异常占6%，可观察到单一异常或多种异常并存。吻合口在组织学上是受损最严重的区域。吻合口处出现的不典型增生、肠化生和上皮内瘤变具有统计学意义（p值在0.02至0.001之间）。最早的术后组织学病变是慢性萎缩性胃炎，平均在术后13年出现，最晚的不典型增生平均在术后18年观察到（p < 0.004）。与慢性萎缩性胃炎无关时，肠化生、上皮内瘤变、囊性扩张和发育异常在术后出现的间隔时间较短（各自的p值：无统计学意义、< 0.03、< 0.0002、无统计学意义）。在我们的患者中，从一种组织学病变转变为更高级病变的概率与处于中高胃癌风险的未切除人群相似。
