Lymphoma in the remaining stomach

　　Benign gastric and duodenal ulcer, malignant tumors occurring 5 to 10 years after the first partial gastrectomy, is called residual gastric cancer. Malignant lymphoma originating from the residual stomach also belongs to a type of residual gastric cancer, but it is extremely rare in clinical occurrence. The etiology of this disease is unknown, and it is speculated to be similar to primary gastric malignant lymphoma. The adjacent connective tissue of the original gastric ulcer is stimulated for a long time, leading to lymphoid hyperplasia and the formation of malignant tumors; after surgery, the residual stomach is stimulated by the chemical substances of refluxed bile and contacted with other chemical substances, leading to a decrease in the body's cell immunity, which induces the malignant transformation of the residual gastric lymphoid tissue.

　　The hazards of residual gastric lymphoma are various, which can affect people's physical health and may cause more serious consequences. Patients in the late stage may experience loss of appetite, recurrent diarrhea, hematochezia, and weight loss.

　　Because of the occurrence of residual gastric lymphoma, at least 5 to 10 years after partial gastrectomy, among the limited case reports of residual gastric lymphoma, the shortest onset time is 9 years after subtotal gastrectomy, and most of them appear 20 years or more after the operation. Therefore, the possibility of primary lymphoma in middle-aged and older patients who undergo benign partial gastrectomy is high.

　　Its main clinical manifestations include bloating, discomfort in the upper abdomen, acid regurgitation, belching, obstruction during eating, progressive intensification of abdominal pain, etc., but they are not specific. In the late stage, there may be loss of appetite, recurrent diarrhea, hematochezia, weight loss, and sometimes palpable masses in the abdomen.

　　The hazards of residual gastric lymphoma are various, which can affect people's physical health and may cause more serious consequences. Therefore, it is necessary to prevent residual gastric lymphoma in a timely manner. The prevention methods for residual gastric lymphoma are:

　　1. Strictly master the indications for benign gastric resection surgery, standardize the operation, and avoid insufficient resection range

　　The view that early gastric resection can prevent the malignancy of peptic ulcer should be abandoned. For patients with benign gastric diseases who are eligible for elective surgery, it is more appropriate to consider surgery after the age of 45. For ulcer disease, especially when performing gastric resection for duodenal bulb ulcer, the extent of resection should not be

　　2. Avoid duodenogastric reflux during gastrointestinal reconstruction

　　Based on the fact that the reflux rate after Billroth-Ⅱ gastric surgery is almost 100%, and 23% for Billroth-Ⅰ, gastrointestinal reconstruction after gastric surgery should avoid the above surgical methods, and try to adopt the long limb Roux-en-Y method or Billroth-Ⅱ+Braun jejunoileal anastomosis or directly choose high-selective vagotomy to reduce or avoid duodenogastric reflux, and reduce the possibility of residual gastric cancer.

　　3. Proficiently master the anastomotic skills

　　During the anastomosis of gastrointestinal reconstruction, it is necessary to improve the anastomotic technique, avoid misalignment and overlap of tissue layers, and reduce the formation of scar tissue; replace absorbable sutures instead of non-absorbable sutures to eliminate the residual stimulation of non-absorbable sutures, thereby reducing the risk of residual gastric cancer.

　　4. Eradicate HP

　　Experts introduce that epidemiological data support a certain etiological relationship between HP infection, chronic atrophic gastritis, and intestinal metaplasia. Currently, HP is considered a confirmed carcinogen and a catalyst for the occurrence of gastric mucosal cancer. Therefore, eradicating HP can significantly reduce the infiltration of inflammatory cells in the mucosal layer, and has a certain preventive effect on the occurrence of residual stomach cancer.

　　5. Regular gastroscopy

　　The longer the time after subtotal gastrectomy, the higher the incidence of residual stomach cancer, so regular gastroscopy is of great significance, which can achieve early detection, early diagnosis, and early treatment of residual stomach cancer.

　　The treatment of residual stomach lymphoma should be to strive for early surgery to explore, clarify the diagnosis and the extent of the lesion, and try to remove the tumor as much as possible. For those with large tumors or those who are in the late stage and difficult to remove, radiotherapy or (and) chemotherapy as the main comprehensive therapy can be performed. Patients with residual stomach lymphoma should pay attention to their diet:

　　① Chew slowly and carefully:Food stimulates the secretion of saliva (containing enzymes beneficial for the digestion of carbohydrates) in the mouth, and careful chewing can make the food particles smaller. The saliva and food are fully mixed, replacing part of the stomach function. Slow swallowing means swallowing slowly, and the interval between swallows should be long to prevent the倾倒综合症 (such as palpitations and dizziness) after rapid swallowing of a large amount of food.

　　② Small and frequent meals:The residual stomach or the intestinal segment connected after surgery cannot compare with the capacity before, and the body needs a longer period of time to adapt to this change. Clinical experience shows that it takes at least 8-10 months to recover to normal daily meals. The initial intake is 8-10 times a day, and the amount of intake is gradually increased while the frequency of meals is reduced. Due to individual differences, the process of adaptation is different.

　　③ Diversified diet:The variety of food can be selected according to the patient's dietary preferences and habits, but attention should be paid to consume as much as possible nutrient-rich and easily digestible high-protein, high-vitamin diet. For example, fish, eggs, fresh vegetables, and fruits (it is best to drink them as juice). Attention should be paid to iron supplementation, because after gastrectomy, the stomach acid that acts on iron (changing trivalent iron to divalent iron) is lost, causing malabsorption. Some iron preparations can be taken orally under the guidance of a doctor. In daily life, iron pots should be used, and more iron-rich foods should be eaten, such as animal livers, spinach, and soy products. Drinking some yogurt is also beneficial.

　　④ Position for eating:For surgery to remove the stomach entrance, to prevent food from regurgitating after eating, it should be kept in a sitting or inclined position; for surgery to remove the stomach outlet, to prevent food from moving down quickly after eating, it is recommended to lie down and rest for about 20 minutes before assuming a free position.

　　⑤ Medications to be taken after meals as advised by the doctor:For example, digestive drugs, vitamin B12, folic acid, etc., which help digestion and absorption and prevent anemia from occurring.

　　⑥ Foods to be limited:Firstly, fried, spicy, and刺激性 foods, as well as raw, cold, and hard foods should be avoided. It is also appropriate to limit foods that are too hot, too sweet, or too salty.

　　⑦ Postoperative dietary requirements:After surgery, fasting until gastrointestinal function is restored, removal of the gastric tube, usually for 5-7 days. On the day of tube removal, a small amount of water or congee can be taken. On the second day, a small amount of liquid food can be consumed. On the third day, more liquid food can be consumed. On the fourth day, semi-liquid food can be consumed, and congee is preferable. From the 5th to the 6th day, soft food can be consumed. From the 7th to the 8th day, normal diet can be started. There is a kind of medicine, which is actually a nutrient, that can be absorbed directly by the human body without gastrointestinal digestion and can reduce the burden on the intestines. For example, Ensure, when dissolved in water, can be used as high-quality liquid food. Fish soup and meat soup with a little cooked meat渣 can be used as good semi-liquid food. During the process of eating, pay attention to whether there is bloating or abdominal pain. If discomfort occurs, reduce the amount of food and temporarily slow down the transition to food, and continue to eat after improvement. For patients with particularly special conditions, dietary issues should be followed according to the doctor's advice.

　　Primary malignant lymphoma at the end of the residual stomach is extremely rare. To consider primary malignant lymphoma of the residual stomach, there must be a history of more than 5 to 10 years after partial gastrectomy due to benign diseases (pathologically confirmed). The treatment of this disease is mainly surgical. The treatment of residual stomach lymphoma should be to strive for early surgery exploration, clarify the diagnosis and extent of the lesion, and as much as possible to remove the tumor. For those with too large tumors or advanced stages that are difficult to remove, radiotherapy or (and) chemotherapy as the main comprehensive therapy can be performed.