Korelacija incidencije nastanka prekanceroznih lezija sa vremenom delovanja duodenogastričnog refluksa i N-nitroznih jedinjenja kod refluksnih i antirefluksnih operacija na želucu – eksperimentalna studija
Sažetak
Uvod/Cilj. Duodenogastrični refluks (DGR) se sreće posle gastroenteroanastomoze, sa ili bez resekcije želuca (Billroth I, Billroth II), posle vagotomije i piloroplastike, gastroduodenostomije, kao i kod neoperisanih bolesnika. Cilj rada bio je da se ispitaju kancerogena svojstva N-nitrozo jedinjenja (MNNG) u sadejstvu sa duodenogastričkim refluksom, u funkciji vremena, na razvoj prekanceroznih lezija u sluzokoži želuca. Poseban cilj bio je da se preporuči metoda hirurške prevencije štetnog delovanja DGR-a na sluznicu želuca, kao mogućeg aktivatora kancerogeneze. Metode. Istraživanjem je obuhvaćeno 90 eksperimentalnih pacova, muškog pola, Wistar soja, podvrgnutih dvema operativnim procedurama: Billroth II (grupa B2) i resekciji želuca sa Roux Y rekonstrukcijom (grupa RY). U kontrolnoj grupi (grupa C) životinje nisu bile operisane. Svim grupama je per os dat hemijski kancerogen MNNG. Sve anastomoze su bile urađene ekstramukoznim šavom, a kao šavni materijal korišćen je monofilamentni polipropilen 7–0, i 8–0). Nakon 8, 16 i 24 nedelje, životinje su žrtvovane i urađena je totalna gastrektomija. Rezultati. Patohistološki su analizirani definisani regioni želuca pacova u tri vremenska perioda. Na kraju eksperimenta grupa B2 je pokazala dominantnu incidencu ozbiljnih promena: hiperplazija (0%), gastritis (0%), metaplazija (6.7%), displazija (6.7%), rani rak (20%) i ispoljeni rak (kod 26.7% životinja). Na kraju eksperimenta utvrđena je sličnost dobijenih rezultata u funkciji vremena između RY i C grupe, sa preovladavajućom pojavom blažih promena: hiperplazije (13.3% i 0%, redom), gastritisa (13.3% i 13.3%, redom), metaplazije (6.7% i 13.3%, redom), displazije (66.7% i 66.7%, redom), upadljivo malom incidencijom ranog karcinoma (0% i 6.7%, redom) i odsustvom karcinoma (0% i 0%, redom). Zaključak. Dejstvo samo MNNG na sluzokožu želuca bez prisustva duodenogastričkog refluksa izaziva lakši stepen prekancerogenih lezija. Direktni kontakt MNNG sa gastričkom sluznicom, uz duodenogastrički refluks, indukuje nastanak prekanceroznih lezija i karcinoma. Protokom vremena procenat reverzibilnih promena se smanjuje, a procenat ireverzibilnih lezija i karcinoma povećava. Nedostatak razlike između RY i C grupe potvrđuje gastroprotektivnu ulogu Roux-Y procedure.
Reference
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