KẾT QUẢ ĐIỀU TRỊ PHẪU THUẬT TÚI THỪA DẠ DÀY PHỐI HỢP VỚI UNG THU DẠ DÀY: CA LÂM SÀNG HIẾM GẶP VÀ ĐIỂM LẠI Y VĂN

Abstract

Study aim: 1. Clinical and paraclinical  feature of gastric diverticula associated with gastric cancer and the  surgical result. 2. Review of Literature. Patient and method: Retrospective study, Case report (Rare diseases). Result: - Female patient, aged of 59 years old, hospitalization due to epigastric pain and weightloss, nausea dyspepsia, belching, a vague sensation of postpradial fullness. Uppon physical examination: no palpable  abdominal mass. - Medical history: + Duodenal ulcer, coughing and sputum. - Upper gastroduodenal scopy revealed gastric cancer 1cm in diameter located at antrum.(AC poorly differantiated). - Abdominal CTScaned revealed tumor of antrum mesuring 10-27 mm. - Red blood cell counts: 5,42 T/L; Hb 116 g/L, Hematocrit 0,36 L/L. white blood cell counts: 7,64 G/L, Platelete  238 G/L. - Biochemistry: Ure 8,5 mmol/L; Creatinin 55,84 mmol/L; GOT 22,98 U/L; GPT 37 U/L, Albumin: 26,37 g/L, Bilirubile 8,5 mmol/L. - Plan operation for gastric cancer: subtotal gastrectomy with D2 lymphadenectomy. - Intra operated  lesion: +Gastric cancer located  at antrum mesuring 2-3 cm. + Duodenal ulcer. + Gastric diverticule 1 cm from cardia in upper lesser sac mesuring 3-5 cm which had no longitudial muscle  fiber  and thin circular muscle fiber with perforated during lyphadenectomy on group number 1. - Procedure performed: Subtotal gastrectomy with D2 lymphadenectomy. Gastric divecticulectomy with interrupted suture of gastric wall and round ligament patch to the gastric wall along lesser curvature, Nissen fondoplication. -Histopathology: Adenocarcinoma moderated differentiated, 2 positive lymph node (22 nodes retrieved). - Complication: Fistula with 500-600 ml per day from resected lesion of gastric diverticula. Total parenteral nutrition in 2 week and jejunostomy for feeding. The fistula healed after 2 week post jejunostomy. - Upper gastroduodenal series showed no fistula. - Patient discharged after  1 month and half. Conclusion: Gastric diverticula located at upper lesser curvature associated with gastric cancer and duodenal ulcer was very rare diasease. The gastric diverticula should be diagnosed preopergation  in order not to be perforated during lymphadenectomy (for gastric cancer curative surgery). 2 methods  should be used for diagnose of  gastric diverticular were upper gastrointestinal radiologic study or upper gastroduodenal scopy. In case of wide neck of  gastric diverticula that located at upper lesser curvature (inside lesser sac) and there were not longitudinal muscle fiber, care must be taken not to make it perforated during lymphadenectomy.