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目的探讨残胃癌的发生机理。方法将９条试验用杂种犬随机分成３组，均行胃大部切除术，行不同方式胃肠重建。Ｂ－Ⅰ组：３条，Ｂｉｌｒｏｔｈ－Ⅰ（Ｂ－Ⅰ）式胃肠重建；Ｂ－Ⅱ组：３条，Ｂ－Ⅱ式胃肠重建；Ｒｏｕｘ－ｙ组：３条，Ｒｏｕｘ－ｙ型胃肠重建。３组实验犬分别于术中及术后６个月，行残胃内胆汁酸测定、细菌鉴定及胃粘膜病理学检查。临床中，回顾性分析２０年间的２６例残胃癌病人，统计不同式术所占的百分比。结果Ｒｏｕｘ－ｙ组残胃内结合型胆汁酸、菌群种属、病理学检查与正常对照组无显著差异；Ｂ－Ⅱ组残胃内胆汁酸含量最高，菌群移位最复杂，病理损害最严重；Ｒｏｕｘ－ｙ式者为０，Ｂ－Ⅰ式占３１％，Ｂ－Ⅱ式占６９％。结论实验犬中，Ｒｏｕｘ－ｙ组、Ｂ－Ⅰ、Ｂ－Ⅱ组残胃内胆汁酸含量依次升高，菌群移位逐渐繁杂，病理损害依次加重。这与临床中上述３种手术方式的胃肠重建后，残胃癌的发生率依次增加相符合。残胃癌的发生机理推测与残胃内胆汁酸含量、菌群移位有关。
Objective To explore the mechanism of gastric stump cancer. Methods The 9 Mongrel dogs were randomly divided into 3 groups. All patients underwent subtotal gastrectomy and were performed different ways of gastrointestinal reconstruction. Group B-I: 3, Bilroth-I (B-I) gastrointestinal remodeling; B-II: 3, B-II gastrointestinal remodeling; Roux-y: 3, Roux-y stomach Intestinal reconstruction. Three groups of experimental dogs were performed intraoperatively with bile acid determination, bacterial identification and pathological examination of gastric mucosa during and 6 months after operation. Clinically, retrospective analysis of 26 cases of gastric stump patients over 20 years, the percentage of different types of surgery. Results There was no significant difference in the Roux-y group of bile acids, bacterial species and pathological examination between the residual stomach and the normal control group. B-II group had the highest content of bile acids in the residual stomach, and the most complex bacterial shift, pathological lesions. The most serious; Roux-y is 0, B-I is 31%, and B-II is 69%. Conclusion In the experimental dogs, the content of bile acids in Roux-y group, B-I, B-II group increased in turn, and the bacterial colony shift became complicated, and the pathological damage was increased in turn. This is consistent with the sequential increase in the incidence of residual gastric cancer after gastrointestinal remodeling in the above three surgical procedures. The mechanism of gastric stump cancer is presumed to be related to the content of bile acid in the residual stomach and the migration of bacterial flora.