胃全摘ならびに噴門側胃切除後の食道鏡および生検所見について

Esophagoscopical and Histological Study on the Patients with Total Proximal Gastrectomy

　最近は手術手技，麻酔，術前術後の管理などの進歩，改善に伴って胃全摘，噴門側胃切除術などが日常盛んに行なわれるようになった．しかしこれら手術では通常の幽門側胃切除術に較べ術後の栄養，貧血，逆流性食道炎，断端部癌再発，社会復帰などの点でなお多くの問題が残されている．

　筆者らは最近5年間に当教室で手術した胃全摘および噴門側胃切除後の患者に対して町田食道ファイバースコープ（FES）による食道，食道空腸あるいは食道胃吻合部，空腸脚，幽門側残胃の内視鏡的観察を行ない，同時に各所の生検組織検査を施行し，特に食道については逆流性食道炎の実態を愁訴，内視鏡，組織学的立場から究明し，これらを相互に比較検討した．

　We studied fiberesophagoscopically and histologically of the esophagus, stoma, jejunal loop and antral gastric remnat in 22 patients; 15 with total gastrectomy, 7 with proximal gastrectomy.

　Study was done especially with reference to reflux esophagitis. Intensity of complaints, endoscopical appearances and histological findings were each classified into 3 degrees; slight, moderate and severe, and relationship of each of these with one another has been studied. While the group classified as severe symptomatically were found to be severe as well endoscopically and histologically considered, not all correlation was found in the other 2 groups.

　Relative severe esophagitis was more often found in the proximally gastrectomized as compared with cases of total gastrectomy. Various methods of surgical reconstruction of the esophago-intestinal passage after total gastrectomy did not show any remarkable difference in the degree of subsequent esophagitis.

　It was clarified that symptoms were influenced by many factor such as postoperative period, psychosomatic condition, lying posture and dietary regimen.

　The esophago-jejuno and gastrostomas were gradually cleared up with the lapse of postgastrectomy period. However, the pathologic findings such as erosion, ulcer, remaining suture material and recurrence of carcinoma were not infrequently observed at the stomal region.

　The insertion of fiberesophagoscope into the jejunal loop beyond the stoma was easely performed in every case. No other pathologic findings were revealed in the mucous membrane of jejunum except for the edema and fibrosis of the lamina propria mucosae appearing in 1 case.

　The antral gastric remnant in 7 patients with proximal gastrectorny was examined. Five of intestinal metaplastic gastritis and 2 of superficial atrophic gastritis were correctly diagnosed endoscopically and histologically.