92例残胃病变临床分析

CLINICAL ANALYSIS OF 92 CASES WITH STUMP GASTRIC LESION

本文报告经内镜检查结合活检确诊的胃大部切除术后残胃粘膜病变92例,其中残胃炎89例,残胃癌3例。上腹痛(41%)、黑粪(15.2%)、腹胀(12%)与嗳气(3.3%)为其主要症状。早期残胃癌往往无明显症状,一旦出现症状,多属进展期。本组残胃癌3例均为毕氏Ⅱ式,在手术8年后发生。对胃良性病变行胃大部切除毕氏Ⅱ式术后,尤其是术后5年以上,年龄大于45岁者定期作内镜复查;可能发现早期残胃癌。良性消化性溃疡病人仍以药物治疗为首选,对需要毕氏Ⅱ式手术者应尽可能采用残胃空肠长襻 Roux-en-Y 吻合术,以减少残胃癌的发生。

This paper reports ninety-two cases with stump gastric lesion after partial gastrec-tomy confirmed by endoscopy combining biopsy,There were eighty-nine cases withstump gastritis and three cases with cancer of gastric stump.The main symptoms wereepigastric pain(41%),melena(15.2%),bloation(12%)and belching(3.3%).Threecases developed cancer of gastric stump proved by gastroscopy biopsy and pathology.The severity and distribution of gastric mucosa lesion and reflux of bile were moreprominent in Billroth type Ⅱ gastrectomy patients than in those of Billroth type I gas-trectomy.Among cases with gastric stump cancer three cases haa been done Billrothtype Ⅱ gastreetomy.All occurred more than eight years after operation.The drug the-rapy is of choice for benign peptic ulcer,When operation is nesessary,Roux-en-Y procedure is recommended to reduce the occurrence of gastric stump cancer.