Duodenogastric reflux and gastric stump carcinoma.
Duodenogastric reflux and gastric stump carcinoma.
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DOI：
10.1007/s101200200002
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发表时间：
2002-01-01
期刊：
影响因子：
--
通讯作者：
Kondo, Ken
中科院分区：
文献类型：
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作者：
Kondo, Ken
胃良性疾病术后残胃癌是目前公认的一个独特的临床实体。残端癌常发生在吻合口，即胃反流严重的部位。由于这个原因，良性疾病的Billroth II手术后的胃反流，包括胆汁和胰液的反流，经常被讨论为与残端癌发展相关的重要因素。胆汁酸是十二指肠液的主要成分，许多实验表明胆汁酸与胃癌的发生有关。特别是，未使用致癌物N-甲基-N '-硝基-N-亚硝基胍（MNNG）的大鼠模型显示残胃腺癌，这与胃反流的严重程度有关。然而，人类的数据不可避免地不那么一致。残端癌的发病率是否高于一般胃癌的发病率仍有争议。关于良性疾病后残端癌的组织发生，囊状息肉性胃炎（GCP）与胃型腺癌之间的关系已被提出。近年来，良性疾病导致残胃癌的危险人群明显减少，而恶性疾病手术后残胃癌的发病率却不断上升。胃反流对恶性疾病后残胃的影响可能不同于其对良性疾病后残胃的影响。残胃癌的发病因素有待于进一步的临床研究。
Gastric stump carcinoma after gastric surgery for benign disease is now widely recognized as a distinct clinical entity. The stump carcinoma was often found to be localized to the anastomosis, known to be the site with severe duodenogastric reflux. For this reason, duodenogastric reflux, including the reflux of bile and pancreatic juice, after a Billroth II procedure for benign disease is frequently discussed as an important factor related to the development of stump carcinoma. Many experiments have implicated bile acids, the main component of the duodenal juice, in gastric carcinogenesis. In particular, rat models without the use of the carcinogen, N-methyl-N'-nitro-N-nitrosoguanidine (MNNG), showed adenocarcinoma in the remnant stomach that was related to the severity of duodenogastric reflux. However, human data are, inevitably, much less consistent. Whether the incidence of stump carcinoma is higher than that of gastric carcinoma in general is still controversial. Concerning the histogenesis of stump carcinoma after benign disease, a relationship between gastritis cystica polyposa (GCP) and gastric type adenocarcinoma has been suggested. Recently, the population at risk of gastric stump carcinoma for benign disease has been diminishing significantly, and the incidence of gastric stump carcinoma after surgery for malignant disease has been increasing. The influence of duodenogastric reflux in the gastric remnant after malignant disease may differ from its influence in the gastric remnant after benign disease. Further clinical study is needed to elucidate the pathogenetic factors involved in gastric stump carcinoma.