背景:一种胃旁路吻合术(OAGB)现在是世界上第三大最常见的减肥手术。这个程序越来越引起人们的注意,但其胆汁反流的并发症和胃癌发生的相关风险仍存在争议。
目的:本研究旨在通过比较OAGB手术前和术后2年胃粘膜的病理和免疫组织化学结果,评估胆汁反流对胃粘膜的影响。
方法:这项回顾性研究分析了OAGB手术前后胃镜检查中观察到的胃部病变。对来自近端的粘膜样本进行病理检查,胃的中部和远端,特别关注Ki-67,P53和CDX2在免疫组织化学中的表达。Ki-67表示细胞增殖,P53是一种肿瘤抑制蛋白,CDX2是肠分化的标志物。
结果:共16例患者完成随访。关于胃炎,术前非糜烂性胃炎有2例(12.5%),术后6例(37.5%)。糜烂性胃炎从手术前1例(6.2%)增加到手术后3例(18.7%),总数从3起增加到9起(p=0.028)。胃中的胆汁反流从手术前的1例(6.2%)增加到手术后的3例(18.7%)。大多数病变在近端,中间,胃的远端部分相对温和,以正常组织状态为主。在所有三个区域都发现了轻度炎症,而中度炎症,肠上皮化生,腺体萎缩较少见。没有发现严重炎症的病例。胃生物标志物CDX-2、Ki67和P53的表达在分歧区域无显著统计学差别。
结论:OAGB后确实发生胆汁反流,但发病率不高。根据OAGB后2年胃粘膜的免疫组织化学和病理结果,OAGB与胃管周围的致癌炎症之间似乎没有显着的因果关系。
BACKGROUND: One anastomosis gastric bypass (OAGB) is now the third most common bariatric surgery worldwide. This procedure is garnering increasing attention, but its complication of bile reflux and the associated risk of gastric carcinogenesis remains controversial.
OBJECTIVE: The study aims to assess the impact of bile reflux on the gastric mucosa by comparing pathological and immunohistochemical results of gastric mucosa before and 2 years after OAGB surgery.
METHODS: This retrospective study analyzed gastric lesions observed in gastroscopy before and after OAGB surgery. Pathological examinations were conducted on mucosal samples from proximal, middle and distal part of stomach, with a particular focus on the expression of Ki-67, P53, and CDX2 in immunohistochemistry. Ki-67 indicates cellular proliferation, P53 is a tumor suppressor protein, and CDX2 is a marker for intestinal differentiation.
RESULTS: A total of 16 patients completed the follow-up. Regarding gastritis, presurgery nonerosive gastritis was found in two cases (12.5%), and postsurgery in six cases (37.5%). Erosive gastritis increased from one case (6.2%) presurgery to three cases (18.7%) postsurgery, totaling an increase from three to nine cases (p = .028). Bile reflux in the stomach increased from one case (6.2%) presurgery to three cases (18.7%) postsurgery. Most lesions in the proximal, middle, and distal part of stomach were relatively mild, with normal tissue states being predominant. Mild inflammation was found in all three areas, whereas moderate inflammation, intestinal metaplasia, and glandular atrophy were less common. No cases of severe inflammation were noted. The expression of gastric biomarkers CDX-2, Ki67, and P53 showed no significant statistical variation in different areas.
CONCLUSIONS: Bile reflux does occur after OAGB, but its incidence is not high. Based on the immunohistochemical and pathological results of the gastric mucosa 2 years post-OAGB, there seems to be no significant causal relationship between OAGB and oncogenic inflammation around the gastric tube.