雙重腫瘤－食道癌病人接受切除手術後於重建胃管上發現腺癌之治療：一外科病例報告

一位75歲的男性病人因第三T3NOMO期食道癌接受食道切除及化學治療的手術。六年後病人感覺吞嚥困難，檢查發現在重建胃管處靠近幽門處有一腺瘤。於是他接受全胃切除術，及空腸重建食道手術。至今追蹤一年情況良好。文獻記載食道癌病人有雙重腫瘤者並不罕見，尤其在日本與胃癌，以及在西方國家與頭頸部癌症關係較密切。但發生在重建食道所用的胃管則較為少見。因此，這種病人常會延誤診斷，且預後較差。如果重建路徑在皮下則因可觸摸到而較易於診斷。從這一例病人我們認為食道癌病人接受切除重建手術後，仍應定期追蹤胃鏡，以期早期發現復發或其它原發性癌症。
A 75-year-old male underwent chemoradiation therapy and esophagectomy for a T3NOMO squamous cell cancer of the upper thoracic esophagus. Six years later he developed dysphagia. An adenocarcinoma was found in the prepyloric region of the antethoracically placed gastric tube. He then underwent a total gastrectomy with a pedicled Roux-en-Y jejunal loop reconstruction, and has been living well without evidence of recurrence for one year. The literature shows that double cancer is not rare in patients with esophageal cancer, especially (in Japan) an association of gastric cancer, and head and neck cancer (western countries). However, carcinomas developing in the transposed gastric tube are rare. Consequently, the detection of a second primary tends to be delayed, and prognosis is poor. Cancer in the transposed in a antethoracically placed gastric tube is more easily found. Diagnosis and treatment are much more difficult with a retrosternally or intrathoracically placed stomach. Only by periodic routine scopic check-up can one make the diagnosis of respectable tumors of the gastric tube in the intrathoacic locations.