Carcinoma of the Stomach after Gastro-Jejunostomy
Carcinoma of the Stomach after Gastro-Jejunostomy
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胃空肠造口术后胃癌
DOI：
10.1136/bmj.1.3392.15
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发表时间：
1926
影响因子：
--
通讯作者：
G. Beatson
中科院分区：
文献类型：
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作者：
G. Beatson
关于单纯性胃溃疡转变为癌性溃疡的可能性，最近进行了大量的讨论，对于这种发生的频率，存在相当大的意见分歧。在长期胃溃疡的病例中出现癌变与现在广泛接受的事实是一致的，即它是任何形式的刺激的常见后果，并且很可能被认为是一种可能和可能的发展。同样地，考虑到现在胃病变行胃肠吻合术的频率，由于这种手术必然伴随着一定量的瘢痕组织（也是癌过程的有利病灶）的存在，如果这种人工开口在几年内成为癌的位置，也不会令人惊讶。关于这两点，下面这个病例是我在格拉斯哥皇家癌症医院治疗的，很有意思，我想也很有意义。一位52岁的售票员，已婚，1921年11月21日因胃部肿瘤入院。随病人一起寄出的信中提到，1910年在格拉斯哥的西部医院，肯尼迪·达勒爵士曾为他做过胃肠吻合术。1920年，他因胃功能紊乱复发再次入院，当发现胃小弯有癌性生长，向下延伸到后壁并累及胃肠吻合口的新开口时，进行了剖腹手术。左侧肋骨下腹膜中也有继发性生长。在这种情况下，没有进一步的东西，伤口被缝合了。当他住进格拉斯哥皇家癌症医院时，他处于非常贫血和消瘦的状态，体重只有6英磅。11磅，他身高5英尺。2英寸触诊可感觉到胃部肿瘤。该病例在癌症医院的临床病史较为平静，但他有周期性的胃功能紊乱发作，伴有呕吐，有时腹泻。呕吐物主要是他吃坏的食物。他逐渐衰弱，于1922年4月8日去世。
A GOOD deal of discussion has recently taken place as to the liability of a simple gastric ulcer to become carciniomatous, and there is considerable difference of opinion as to the frequency of such an occurrence. The appearanceof carci-noma in the case of a long-standing gastric ulcer would be in keeping with the now widely accepted fact that it is a frequent sequel of irritation in any form, and would be a development that might quite well be regarded as both possible and probable. In the same way, considering th'frequency with which gastric lesions are now treated by gastro-enterostomy, followed as this operationi must be by the presence of a certain amount of scar tissue (also a Favourahle nidus for the cancer process), it wvould niot be surpr-ising if such an artificial opening niighit, in the course af years, become the seat of carcinoma. Relative to these two points the following case, which was unlder my care at the Glasgow Royal Cancer Hospital, is of interest, and, I thiiik, hassome bearing.A car-conductor, aged 52, married, was admitted on November 21st, 1921, suffering from a tumour of the stomach. The letter sent with the patient gave the information that he had been operated upon by Sir Kennedy Dalziel at the Western Infirmary Glasgow, in 1910, when gastro-enterostomy was performed. further stated that in 1920 he was readmitted there with a recurrence of gastric disturbance, and laparotomywas performed when it was found that there was a carcinomatous growth o the lesser curvature, stretching down the posterior wall and involving the new opening of the gastro-enterostomy. There were also secondary growths in the peritoneum beneath the left ribs. Under these conditionsnothing further was donie, anid the wound was closed. When admitted to the Glasgow Royal Cancer Hospital he was in a very anaemio andemaciated condition, weighiing only 6st. 11 lb., hisheight being 5 ft. 2 in. The gastric tumour could be felt on palpation. The clinical history of the case while in the Cancer Hospital was somewhat uneventful, buit he had periodic attacks of gastric disturbance, with some vomiting and, at times diarrhoea. The matter vomited was chiefly the food that he bad taken. He got gradually weaker, and died on April 8th, 1922.