gastric stump
Introduction
Introduction to gastric cancer Gastric gastric cancer (cancerofgastricremnant) is also known as gastric cancer after gastric surgery, because it can occur in the residual stomach after major gastrectomy, can also occur in simple gastrointestinal anastomosis, simple perforation repair or vagus nerve cut in the whole stomach, generally It is considered that it should be limited to gastric cancer that occurs after surgery for gastric non-cancerous lesions. If the operation is due to malignant lesions, it should refer to gastric cancer that occurs more than 20 years after surgery. The predilection site of residual gastric cancer is anastomotic, but it can also be diffuse. Throughout the stomach. basic knowledge The proportion of illness: the incidence rate is about 0.0001% - 0.0002% Susceptible people: no specific population Mode of infection: non-infectious Complications: abdominal pain, anemia
Cause
Residual gastric cancer
Atrophic gastritis (35%):
After partial gastrectomy or vagus nerve ablation, the stomach is in a low acid or acid-free state. The secretion of gastrin decreases, the protective mucus is reduced, the gastric mucosa gradually shrinks, and the bile, pancreatic juice and intestinal fluid reflux after gastric surgery are more damaged. Gastric mucosa, the formation of chronic atrophic gastritis, intestinal metaplasia and dysplasia, is an important cause of residual gastric cancer.
Reduced gastric acid (25%):
It is beneficial to the growth and reproduction of bacteria in the stomach, the metabolic products of bacterial toxins and bile being decomposed by bacteria, and can promote cancer, while the bacteria containing nitrate reductase can promote the synthesis of carcinogenic nitrosamines. Under the action of cancer-promoting substances, the gastric mucosa may become cancerous.
Postoperative scar (25%):
Even the stimulation that does not absorb sutures may be one of the factors that cause gastric cancer. In short, gastric surgery changes the normal anatomy and physiological function of the stomach, making the stomach more exposed to carcinogens, under the action of cancer-promoting substances, when the body's immune function is low, residual gastric cancer can occur.
Prevention
Residual gastric cancer prevention
Residual gastric cancer is also called postoperative gastric cancer, and the main site is the residual stomach after gastric resection. There are many kinds of harms to gastric cancer, which will affect people's health and cause more serious consequences. Therefore, it is necessary to prevent residual gastric cancer at an early stage.
Residual gastric cancer prevention methods:
1. Strictly grasp the indications for benign gastric resection, standardize the operation, and avoid the lack of resection:
In the past, the idea that early gastric resection can prevent malignant transformation of peptic ulcer should be abandoned. Patients with benign gastric diseases who can undergo elective surgery should consider surgery after 45 years old. Ulcers, especially duodenal bulb ulcers, should be removed from the stomach by less than 60% to ensure the purpose of surgical acid reduction.
2, gastrointestinal reconstruction should avoid duodenogastric reflux:
After the Billroth-II gastric surgery, the reflux rate is almost 100%, and the Billroth-I type is 23%. The gastrointestinal reconstruction after gastric surgery should avoid the above procedure. Try Roux-en-Y or Billroth- II+Braun gastrojejunostomy or direct selection of highly selective vagotomy to reduce or avoid duodenogastric reflux and reduce the possibility of residual gastric cancer.
3, proficient in matching skills:
When the gastrointestinal reconstruction is anastomosed, it is necessary to improve the technique of anastomosis, avoid overlapping of dislocations of the tissue level, and reduce the formation of scar tissue; instead of using absorbable suture instead of non-absorbing suture, eliminate the residual stimulation of non-absorbed suture, so as to reduce the occurrence of residual gastric cancer. Dangerous.
4. Eradicate HP:
Experts said that epidemiological data support HP infection and chronic atrophic gastritis and intestinal metaplasia have a certain etiological relationship, HP is currently considered to be a definite carcinogenic factor, but also a trigger for gastric mucosal cancer, so eradication HP can significantly reduce the infiltration of mucosal inflammatory cells, which has a certain preventive effect on the occurrence of residual gastric cancer.
5, regular gastroscopy:
The longer the operation after partial gastrectomy, the higher the incidence of residual gastric cancer. Therefore, regular gastroscopy is of great significance, and early detection, early diagnosis and early treatment of residual gastric cancer can be achieved.
Complication
Residual gastric cancer complications Complications, abdominal pain, anemia
Mainly have abdominal pain, vomiting, melena, weight loss, anemia and other complications.
Symptom
Symptoms of residual gastric cancer Common symptoms Fecal black with blood and stomach appetite decreased appetite, persistent pain, black stool, anemia, cancer, advanced gastrointestinal symptoms
1. More than 5 years after gastrectomy, persistent upper abdominal pain, loss of appetite, weight loss, persistent stagnation of fecal occult blood, acid production, and antispasmodic agents can not alleviate pain.
2. The upper abdomen may have tenderness or touch the mass.
Examine
Examination of residual gastric cancer
1. Have a history of gastrectomy for more than 5 years.
2. Sustained pain in the upper abdomen, loss of appetite and weight loss.
3. Fecal occult blood continues to be positive.
4. X-ray barium meal examination: In most cases, there is a filling defect in the residual stomach, but it should be differentiated from the proliferation of benign mucosal folds around the anastomosis. X-ray examination is difficult for early lesions.
5. Gastroscopic examination is more reliable, and can be used for biopsy to confirm the diagnosis.
Diagnosis
Diagnosis and diagnosis of residual gastric cancer
1. Because surgery changes the normal anatomy and physiological function of the stomach, X-ray barium meal imaging can often miss smaller lesions, so the diagnosis rate is about 50%.
2. Gastroscopic examination and mucosal biopsy of suspicious parts are the main methods for diagnosing this disease. Its diagnosis rate is over 90%. In addition, the diagnosis of residual gastric cancer should be differentiated from recurrent gastric cancer. Most patients with gastric benign lesions have undergone major gastrectomy or subtotal gastrectomy. Gastrointestinal anastomosis, recurrent cancer in the stomach are called gastric cancer. However, due to gastric cancer for major resection of the stomach or subtotal resection, gastrointestinal anastomosis, recurrence of gastric cancer after surgery, there are residual gastric cancer and recurrent gastric cancer, usually 5 years after surgery as the boundary, occurred after surgery More than 5 years are considered for cancer recurrence, and gastric cancer that occurs after 5 years is mostly residual gastric cancer.
