Yasunori Mikami

Regurgitant bile acids and mucosal injury of the gastric remnant after partial gastrectomy

Three groups, each consisting of seven patients who had undergone either Billroth I, Billroth II, or pylorus-preserving gastrectomies, were evaluated more than 18 months postoperatively in terms of concentration and amount of bile acids in the gastric aspirate and histologic changes in the gastric remnant mucosa. Concentrations of bile acids were determined by gas chromatography and mucosal specimens were obtained by endoscopic biopsy. The total bile acid concentration and all of the individual fractional bile acid levels, whether free or conjugated, were significantly higher in the Billroth II group than in the other two groups. The amount of gastric aspirate was also highest in the Billroth II group. Endoscopic biopsy revealed glandular dysplasia to be predominantly in the Billroth II group. The presence of bile acids in the gastric remnant may contribute to mucosal injury, possibly leading to cancer in the gastric remnant, especially after the Billroth II operation.

Adverse Effects of Regurgitant Duodenal Content on the Mucosa of the Residual Stomach After Partial Gastrectomy

Three groups of patients partially gastrectomized by Billroth II, Billroth I or pylorus-preserving procedure were evaluated for amount of bile acids in the gastric aspirate and histologic changes in the remnant gastric mucosa. The amount of bile acids was the highest and glandular dysplasia of the mucosa most predominant in the B-II group. Rats with either gastrojejunostomy or simple gastrotomy were maintained with an usual laboratory diet. Intestinal type adenoma and carcinoma developed exclusively in the gastrojejunostomized rats. Prolonged exposure of the gastric mucosa to bilious content may result in its histological changes that possibly lead to development of carcinoma.

Increased Risk of Gallstones following Curative Gastrectomy for Cancer

The incidence of gallstones in patients who had undergone radical gastrectomy for cure of gastric cancer was 4–8 times higher than in the general population. At least two factors seem to be involved in this high incidence: one is complete vagotomy which is inevitable in gastrectomy with lymph node dissection, and the other perioperative hepatic dysfunction. One fourth of these patients with gallstones required cholecystectomy with or without T-tube drainage. The high incidence of gallstones and a rather difficult cholecystectomy we experienced forced us to perform prophylactic cholecystectomy in these gastric cancer patients diagnosed with: cirrhosis or hepatitis; hemophilia or other hematologic disorders, and the cancer lesion involving the aborad part of the stomach.

Ultrasonographic study of gallbladder motility in gastrectomized patients for gastric cancer.

胃癌に対する胃全摘および胃亜全摘後の胆嚢運動機能をより生理的な手段である超音波診断装置を用いて経時的に検討した. 対照群21例では最大収縮率62.2%を示し, 空腹時胆嚢面積は12.9cm2であった. 術後早期27例は対照群に比べ最大収縮率35.7%と有意に収縮不良であり, 空腹時胆嚢面積も15.9cm2と有意に拡張していた. 再建術式別でみるとρ吻合で収縮不良傾向が強く, 空腹時胆嚢面積も他術式より拡張していた. 術後後期34例では対照群に比べ差はなく最大収縮率64.3%と収縮良好であったが, 空腹時胆嚢面積は15.3cm2と有意に拡張していた. 再建術式別では各術式間に差はなく良好な収縮を示した. なお, 空腹時胆嚢面積はρ吻合で拡張傾向が強かった.

Effect on survival term of stage IV carcinoma of the stomach, with or without resection and its adjuvant therapies.

StageIV胃癌486例の検討において, 胃癌病巣切除例の50%生存期間は246～247日, 1年生存率は35, 5～37.0%で, 非切除の101～102日, 0.7～10.0%より有意に高い値を示した. また手術に併用した補助療法のうち化学療法には有用性が示されたが, 遺残癌病巣内OK-432大量局注および肝転移巣への動注療法では有意の延命効果がなかった. また非切除姑息術式中で空置的胃腸吻合は最も良好であったが, 50%生存期間は153日, 1年生存率もたかだか20.0%の成績に留まった. 以上よりStage IVという高度に進行した胃癌では積極的胃癌病巣切除が大切で, しかる後化学療法の併用によりさらに延命が期待できるものと判断された.

Long term observation of gastric mucosa following partial gastrectomy for benign conditions: Chronic gastritis of remnant stomach in pathogenesis of carcinoma.

胃良性疾患のため胃部分切除を施行しBillroth II法で再建した43例について術後7～21年6ヵ月経過後の胃粘膜を検討対象とした.内視鏡所見では吻合部の発赤・びらんは30.3%, ポリープ病変は11.6%にみられたが, これと胆汁逆流との因果関係は明らかでなかった.残胃生検標本において固有胃腺萎縮の程度は吻合部に最も高度で, その改築像としての偽幽門腺化, 腺管嚢胞状拡張および腺管異型の所見も同部に高頻度で出現した.しかし術後15年を境に症例を2群に区分して各組織所見の出現頻度を比較すると後半の症例で増加する傾向は認められなかった.また腸上皮化生が残胃に新生したものは4.7%と著しく低率であることを指摘した.