Yasoshima T, Denno R, Ura H, Mukaiya M, Yamaguchi K, Hirata K
First Department of Surgery, Sapporo Medical University School of Medicine, Japan.
Surg Today. 1998;28(12):1270-3. doi: 10.1007/BF02482813.
We present herein the first reported case of a deep ulceration developing in the pouch of a jejunal side-to-side anastomosis following the interposition of a jejunal U-shaped pouch (jejunal pouch), performed as reconstruction. A 47-year-old woman underwent a proximal gastrectomy and interposition of a jejunal pouch for early gastric cancer, 4 months after which she began to develop a fever. Esophagogastroscopy revealed a deep ulceration in the side-to-side anastomosis of the jejunal pouch. Her serum gastrin level was much higher than the normal range, and 24-h monitoring of the intraremnant stomach pH revealed that it was below 7.0 at night. A peptic ulcer was thought to be one of the causes of the pouchitis. Due to the drug-resistant ulceration and fever, a reoperation was performed, in which the jejunal pouch and remnant stomach were removed and Roux-en-Y reconstruction was done. There were no postoperative complications, and the fever resolved after surgery. Reconstruction of the jejunal pouch after proximal gastrectomy is recommended from the standpoint of quality of life (QOL); however, further studies on the size of the remnant stomach and the length of the interposed jejunal pouch are necessary.
我们在此报告首例因行空肠U形袋（空肠袋）间置术作为重建方式后，空肠侧侧吻合袋内出现深部溃疡的病例。一名47岁女性因早期胃癌接受了近端胃切除术并间置空肠袋，4个月后开始发热。食管胃镜检查发现空肠袋侧侧吻合处有深部溃疡。她的血清胃泌素水平远高于正常范围，对残胃内pH值进行24小时监测发现夜间pH值低于7.0。消化性溃疡被认为是袋炎的病因之一。由于耐药性溃疡和发热，进行了再次手术，切除了空肠袋和残胃并完成了Roux-en-Y重建。术后无并发症，术后发热消退。从生活质量（QOL）的角度来看，推荐近端胃切除术后进行空肠袋重建；然而，有必要对残胃大小和间置空肠袋长度进行进一步研究。
