食管胃吻合术后胃排空障碍探讨

目的 探讨食管胃吻合术后胃排空障碍的原因、合理的预防措施及其有效的治疗方法。方法 回顾性分析我科1982年1月～2002年4月问32例食管胃吻合术后胃排空障碍病人的临床资料。结果 32例胃排空障碍病人，食管胃颈部吻合24例，胸腔内吻合8例。占同期食管癌手术1378例的2．3％。25例功能性胃排空障碍病人中22例经保守治愈，1例死亡，死亡率为4．0％；7例机械性胃排空障碍病人经手术治愈。结论 胃排空障碍多见于高位食管胃吻合术后，以食管胃颈部吻合者多见，其发生与手术操作和术后处理不当有关，胃排空障碍多为功能性，少数为机械性。前者大多可经保守治疗而痊愈，后者则必须手术解除梗阻。本文还对食管癌术后胃排空障碍的定义、诊断与鉴别诊断进行了探讨。     

27例食管癌切除术后胃排空障碍

为探讨食管癌术后胃排空障碍合理的治疗方法及预防措施，对１９８２～１９９５年间２７例食管癌术后胃排空障碍病人的临床资料进行回顾性分析。食管胃颈部吻合者２２例，胸内吻合者５例。占同期食管癌手术２４２７例的１．１％。１８例功能性胃排空障碍病人中１５例经保守治愈，３例死亡；９例机械性胃排空障碍病人经手术治愈。结论：食管癌术后胃排空障碍好发于食管胃颈部吻合者，多为功能性，少数为机械性。因治疗方法不同需强调二者的鉴别诊断。术中精细适度各项操作，可减少机械性胃排空障碍的发生     

食管癌术后胸胃排空障碍临床分析

目的探讨食管癌术后胸胃排空障碍的原因、诊断和治疗。方法胸胃排空障碍19例,其中功能性16例,机械性3例,均发生于术后4~12 d,予保守治疗15例,再次手术治疗4例。结果16例功能性胸胃排空障碍者中,15例经保守治疗治愈,1例因胃穿孔而行胸腔闭式引流剖腹探查及空肠造瘘,另3例机械性梗阻者经剖腹探查治愈。结论食管癌术后胸胃排空障碍多为功能性,少数为机械性,上消化道造影、胃镜检查是鉴别两者的重要方法。对食管癌术后机械性胃排空障碍应采取手术治疗;功能性胃排空障碍多可通过保守治疗治愈。     

食管癌贲门癌术后胸胃排空障碍的临床分析

目的探讨食管癌贲门癌术后胸胃排空障碍的诱因、诊断和治疗。方法回顾性分析1990年1月-2003年12月我院施行1369例食管癌贲门癌切除术的病人临床资料。结果本组病例发生胸胃排空障碍17例,发生率1.24%,其中机械性胸胃排空障碍5例,功能性胸胃排空障碍12例,均发生于术后3～12d,再次手术治疗5例;治愈16例,死亡1例。结论上消化道造影、胃镜是鉴别机械性胃排空障碍和功能性胃排空障碍的重要方法,对食管癌术后机械性胃排空障碍应采取手术治疗,而功能性胃排空障碍采取保守治疗多能好转。     

食管癌贲门癌术后胸胃排空障碍的临床分析

目的 探讨食管癌贲门癌术后胸胃排空障碍的诱因、诊断和治疗。方法 回顾性分析1990年1月-2003年12月我院施行1369例食管癌贲门癌切除术的病人临床资料。结果 本组病例发生胸胃排空障碍17例，发生率1．24％，其中机械性胸胃排空障碍5例，功能性胸胃排空障碍12例，均发生于术后3～12d，再次手术治疗5例；治愈16例，死亡1例。结论 上消化道造影、胃镜是鉴别机械性胃排空障碍和功能性胃排空障碍的重要方法，对食管癌术后机械性胃排空障碍应采取手术治疗，而功能性胃排空障碍采取保守治疗多能好转。     

食管癌切除术后胃排空障碍23例分析

胃排空障碍是食管癌术后一种少见而严重的并发症 ,给患者造成巨大的精神压力和经济负担。自 1975 - 2 0 0 0年我科共施行食管癌切除胃代食管术 1890例 ,术后发生胃排空障碍 2 3例 ,发生率 1.2 %。现报告如下 :1　临床资料　　本组 2 3例 ,男 18例 ,女 5例。其中功能性胃排空障碍 16例 ,机械性胃排空障碍 7例。年龄 4 1- 6 3岁 ,平均5 2岁。全部左侧开胸 ,弓上吻合 18例 ,颈部吻合 5例。术后 3- 5ｄ肠功能恢复后拔除胃管 ,开始全流质饮食。功能性胃排空障碍 16例 ,发生于术后第 1周 10例 ,第 2周 5例 ,第 3周 1例。主要表现为恶心、呕吐、胸…     

食管癌术后胃排空障碍的诊断与治疗

目的探讨食管癌术后胃排空障碍的诊断及治疗。方法对我院于2007年6月至2008年6月间5例食管癌术后胃排空障碍病例的诊断及治疗作回顾性分析。结果1例经保守治疗后出院,4例确诊为机械性胃排空障碍,经手术解除梗阻后治愈出院,术后无严重并发症。结论食管癌术后胃排空障碍根据临床表现、影像学及胃镜检查可确诊,早期鉴别诊断可采用胃排空放射性核素显像。确诊机械性胃排空障碍均必须作外科手术治疗才可以达到满意的效果。     

食管、贲门癌术后胸胃排空障碍的治疗

目的探讨食管、贲门癌切除术后功能性及机械性胸胃排空障碍的治疗措施及效果。方法回顾性分析17例食管、贲门癌术后功能性及机械性胸胃排空障碍患者的临床资料。结果本组中2例经保守治疗1周内症状消失,7例在充分保守治疗2周内痊愈,8例在保守治疗2周后行手术治疗,术后2～3周胃肠功能恢复正常,症状消失,无手术并发症治愈出院,消化道造影示胸胃扩张有回缩、钡剂无潴留。结论食管、贲门癌切除术后胸胃排空障碍应根据患者不同临床表现,合理采取保守或手术等综合治疗。可减少患者痛苦,提高疗效。     

颈胸腹三切口食管癌切除术后胃排空障碍六例

从 1991年 10月至 2 0 0 1年 6月 ,我科经颈胸腹三切口行食管癌切除术 4 2 1例 ,术后并发胃排空障碍 6例 (1.4 3% ) ,其中功能性和机械性各 3例 ,现报告如下。1　临床资料与方法本组共 6例 ,男 4例 ,女 2例 ;年龄 4 6～ 6 7岁 ,平均年龄5 9岁。均为胸上段食管鳞癌患者。TNM分期 期 1例 , 期5例。经右胸后外侧切口切除食管病变 ,腹正中切口游离胃 ,并牵引至颈部行食管胃吻合术。术后 3～ 4天停止胃肠减压 ,7天进流质食物 ,11天进半流质食物。术后 6例发生胃排空障碍患者于停止胃肠减压后 2～ 3天出现胸闷、气促、心悸和呕吐等症状。查体 :…     

胃大部切除术后残胃功能性排空障碍的诊治

目的　探讨胃大部切除术后残胃功能性排空障碍的发病原因、诊断和治疗。方法　对1984年 7月～ 2 0 0 0年 9月施行的 5 12例胃大部切除术后 ,发生的 8例残胃功能性排空障碍的临床资料进行回顾性分析。结果　 8例功能性排空障碍均发生在术后 4～ 8d。 6例行保守治疗治愈出院 ,时间 10～ 18d。 2例行 2次手术 ,术中除吻合口水肿外无其它异常发现 ,经 1个月左右的保守治疗痊愈出院。结论　术后残胃功能性排空障碍是多种因素综合所致 ,消化道造影及胃镜检查是诊断本病及与机械性梗阻鉴别的重要方法 ,非手术治疗可痊愈。     

Functional disorders and quality of life after esophagectomy and gastric tube reconstruction for cancer

Functional disorders such as delayed gastric emptying, dumping syndrome or duodeno-gastro-esophageal reflux occur in half of the patients who undergo esophagectomy and gastric tube reconstruction for cancer. The potential role for pyloroplasty in the prevention of functional disorders is still debated. Antireflux fundoplication during esophagectomy can apparently reduce the reflux but at the cost of increasing the complexity of the operation; it is not widely used. The treatment of functional disorders arising after esophagectomy and gastroplasty for cancer is based mainly on dietary measures. Proton pump inhibitors have well documented efficiency and should be given routinely to prevent reflux complications. Erythromycin may prevent delayed gastric emptying, but it should be used with caution in patients with cardiovascular disorders. In the event of anastomotic stricture, endoscopic dilatation is usually efficient. Problems related to gastrointestinal functional disorders after esophageal resection and gastric tube reconstruction do not significantly impair long-term quality of life, which is mainly influenced by tumor recurrence.     

Post-esophagectomy gastric outlet obstruction: role of pyloromyotomy and management with endoscopic pyloric dilatation.

OBJECTIVE: Gastric outlet obstruction is common after esophagectomy. Our goal was to determine the incidence of gastric outlet obstruction after esophagectomy with or without pyloromyotomy and analyze its management by endoscopic pyloric dilatation. METHODS: Two hundred forty-two patients underwent esophagectomy with gastric conduit from January 2002 to June 2006. Subjects were divided into two groups: Group A had no pyloromyotomy (n=83) and Group B had a pyloromyotomy (n=159). Gastric outlet obstruction was strictly defined to include patients with clinical delayed gastric emptying supported by symptoms, barium swallow studies, persistent air-fluid level and dilated conduit on radiography, or endoscopic or surgical intervention to improve gastric drainage. RESULTS: The groups were similar except for a higher percentage of cervical anastomosis and older age (64- vs 61-year-old) in Group A. The overall incidence of gastric outlet obstruction was 15.3% (37/242). Pyloromyotomy did not reduce the incidence of gastric outlet obstruction (Group A 9.6% vs Group B 18.2%, p=0.078). One patient required a late pyloroplasty. Successful management of gastric outlet obstruction with pyloric dilatation (96.7%, 28/29) was unaffected by pyloromyotomy. There was no difference in length of stay, pneumonia (Group A 27.7% vs Group B 19.5%, p=0.15), respiratory failure or anastomotic stricture. There was no difference in anastomotic leaks when controlling for the anatomic location of the anastomosis (p=0.36). Mortality was equivalent between groups (2.4 vs 2.5%, p=0.96). CONCLUSION: Pyloromyotomy does not reduce the incidence of symptomatic delayed gastric emptying after esophagectomy. Post-operative gastric outlet obstruction can be effectively managed with endoscopic pyloric dilatation. Routine pyloromyotomy for the prevention of post-esophagectomy gastric outlet obstruction may be unwarranted.     

Balloon dilatation of the pylorus for delayed gastric emptying after esophagectomy

OBJECTIVE: Delayed gastric emptying after esophageal operations occurs in up to 50% of patients. A good quality of life, in long-term survivors after esophagectomy, may depend on both dietary adaptation and the improvement of intrathoracic gastric motility itself. The objective of this study was to investigate the effect of pyloric balloon dilatation on the sustained delay of gastric emptying after esophagectomy. METHODS: Two hundred and fifty-seven patients underwent esophagectomy with a gastric conduit from January 2003 to December 2006. A gastric drainage procedure was routinely performed during the esophagectomy. The intrathoracic gastric emptying of solid food was evaluated by radioisotope imaging. A 50% gastric emptying time over 180 min was defined as delayed. We assessed the changes of the intrathoracic gastric emptying time, and the symptoms after balloon dilatation of the pylorus, associated with delayed gastric emptying. RESULTS: Balloon dilatation of the pylorus was performed in 21 patients (8%) who had sustained symptoms of delayed gastric emptying after esophagectomy for esophageal cancer despite the use of prokinetics. The symptoms associated with delayed gastric emptying were improved after balloon dilatation of the pylorus in all patients. Pyloric balloon dilatation was performed twice in two patients. In seven of 19 patients (37%), who had a follow-up gastric emptying study, the delayed gastric emptying rate for 180 min was improved from 30% to 88%. Six patients had slightly improved results, and six patients had no increase in the rate of gastric emptying compared with the previous gastric emptying study. CONCLUSIONS: After balloon dilatation of the pylorus, two thirds of patients with delayed gastric emptying show increased rates of gastric emptying as measured by radioisotope imaging. Mechanical balloon dilatation of the pylorus is a useful method to treat sustained delay of intrathoracic gastric emptying after esophagectomy.     

Minimally Invasive Approach to Esophagectomy

Background:

Recent advances in laparoscopic and thoracoscopic surgery have made it possible to perform esophagectomy using minimally invasive techniques. The aim of this report was to present our preliminary experience with minimally invasive esophagectomy.

Methods:

We reviewed our experience on eight patients who underwent minimally invasive esophagectomy using either laparoscopic and/or thoracoscopic techniques from June 1996 to May 1997. Indications for esophagectomy included stage I carcinoma (5), palliative resection (1), Barrett''s with high grade dysplasia (1) and end stage achalasia (1).

Results:

The average age was 68 years (54-82). The surgical approach to esophagectomy included laparoscopic transhiatal esophagectomy with cervical anastomosis (n=4), thoracoscopic and laparoscopic esophagectomy with cervical anastomosis (n=1), and laparoscopic mobilization with right mini-thoracotomy and intra-thoracic anastomosis (n=3). Conversion to mini-laparotomy was required in two patients (25%) to complete esophageal dissection and facilitate gastric pull-up. The mean operative time was 460 minutes. The mean intensive care stay was 1.9 days (range of 0-7 days) with a mean hospital stay of 13-8 days. Minor complications included atrial fibrillation (n=1), pleural effusion (n=2) and persistent air leak (n=1). Major complications included cervical anastomotic leak (n=1), and delayed gastric emptying requiring pyloroplasty (n=1). There was no perioperative mortality.

Conclusions:

This preliminary experience suggests that minimally invasive esophagectomy is safe and feasible in centers with experience in advanced minimally invasive surgical procedures. Further studies are necessary to determine advantages over open esophagectomy.     

胆道术后21例功能性胃排空障碍的临床治疗分析

目的 探讨胆道术后功能性胃排空障碍的临床诊治经验.方法 总结所有近年我科收治的胆道病人中术后发生功能性胃排空障碍的21例病例,对其病因,临床症状,诊断,治疗进行分析.结果 本组21例病人中的1例在术后14天内恢复,18例在15-30天内恢复,2例在31-45天内恢复.结论 本病属功能性病变,应行非手术治疗.     

Whole stomach transposition without gastric drainage procedure: a good surgical option to restore digestive continuity after esophagectomy

After esophagectomy, the stomach is usually used to restore digestive continuity. To prevent postoperative delayed gastric emptying, most authors perform a gastric drainage procedure or transpose a tubulized stomach. The aim of our work is to evaluate the emptying of a transposed whole stomach without performing a pyloromyotomy or a pyloroplasty. From 1996 to January 2004, 45 patients underwent total esophagectomy for cancer or for caustic stenosis. Reconstruction of digestive continuity was realized through transposition of the whole stomach without performing a pyloric drainage procedure. At 12 months after the intervention, 35 patients (77.8%; 20 men and 15 women) were submitted to a gastric emptying scintigraphic study by means of ingestion of a mixed meal labeled with 37 MBq 99mTc-sulfur colloid. Mean half-emptying time was 71.4 minutes (range, 15-90 minutes; reference range, 83 +/- 34 minutes): all the patients were in the normal range except one. No patient complained of delayed gastric emptying symptoms. After esophagectomy, the transposition of the whole stomach without a pyloric drainage procedure seems to be an interesting option, and is not associated with delayed gastric emptying.     

中西医结合治疗老年人胰十二指肠切除术后胃排空障碍

目的：探讨中西医结合治疗老年人胰十二指肠切除术后胃排空障碍的疗效。方法：对32例年龄大于60岁的胰十二指肠切除术后胃排空障碍患者随机分为两组,治疗组16例采用中西医结合的方法治疗,对照组16例采用常规的方法治疗,分别观察并比较两组疗效。结果：所有32例患者均经非手术治疗后痊愈出院,其中治疗组与对照组在1个月内痊愈例数、2个月内痊愈例数比较有明显优势（P〈0.05）。结论：老年人胰十二指肠切除术后胃排空障碍采用中西医结合治疗有较好的疗效。     

Effect of pyloric drainage procedures on gastric passage and bile reflux after esophagectomy with gastric conduit reconstruction

BACKGROUND AND AIMS: Controversy still exists about the need for pyloric drainage procedures (pyloroplasty or pyloromyotomy) after esophagectomy with esophagogastrostomy and vagotomy. Although pyloric drainage may prevent postoperative delayed gastric emptying, it may also promote bile reflux into the oesophagus. We analysed pyloric drainage methods for their potential effect on gastric outlet obstruction and bile reflux in patients undergoing esophagectomy. MATERIALS AND METHODS: One hundred and ninety-eight patients with esophageal carcinoma were treated by transthoracal esophagectomy with gastric conduit reconstruction either with pyloromyotomy (group II, n = 118), pyloroplasty (group III, n = 34) or without pyloric drainage (group I, n = 46) between January 2000 and December 2004. The postoperative gastrointestinal passage by radiological investigation, anastomotic leakage rate, mortality and incidence of gastroesophageal reflux by endoscopy within the first postoperative year were retrospectively analysed. RESULTS: Patient demographics and the types of surgical procedures did not differ between the three groups. There was no difference in hospital mortality, anastomotic leakage rate, gastrointestinal passage and postoperative hospital stay between the three groups. However, more patients with pyloric drainage showed bile reflux (I = 0% vs II+III=14.9%, p = 0.069) and reflux esophagitis (I = 10.3% vs II+III = 34.5%, p < 0.05) compared to patients without pyloric drainage. On the multivariate analysis, pyloric drainage and the anastomotic height were independent and were significant risk factors associated with postoperative reflux esophagitis. CONCLUSION: Pyloric drainage after esophagectomy with gastric conduit reconstruction should be omitted because it does not improve gastric emptying and may favour biliary reflux esophagitis.     

Effect of colectomy on gastric emptying in idiopathic slow-transit constipation

INTRODUCTION: Gastric emptying is delayed in patients with idiopathic slow-transit constipation (ISTC). Gastric emptying was measured before and after colectomy and ileorectal anastomosis in patients with ISTC to determine whether the abnormality persists after operation. METHODS: Twelve patients undergoing colectomy for severe ISTC had solid-phase gastric emptying measured after an overnight fast. All 12 had an uncomplicated subtotal colectomy and ileorectal anastomosis; 11 had an excellent functional outcome. In ten of these patients gastric emptying was repeated within 3 months of operation. Seven patients (including the remaining two) had the study performed at 1 year. RESULTS: All 12 patients had severely delayed gastric emptying before operation. Gastric emptying remained delayed in the ten patients who underwent an early postoperative gastric emptying study. Six of seven patients assessed at 1 year had improved gastric emptying, of whom four had returned to normal. Functional outcome did not relate to gastric emptying. CONCLUSION: Patients with ISTC have delayed gastric emptying. In some patients this returns to normal after colectomy, but is persistent in others. This may have implications for our understanding of ISTC.     

Collare Anastomosenstenosen nach Magenhochzug beim Ösophaguskarzinom

Common late complications after esophagectomy and gastric tube reconstruction for esophageal carcinoma are symptomatic, benign fibrotic stenoses of the cervical anastomosis, which require dilatation. Since the prognosis of esophageal carcinoma still remains poor, bad functional results such as dysphagia affect quality of life. In a retrospective analysis, our patients were evaluated with regard to the underlying effects of cervical anastomotic stenosis after esophagectomy and gastric tube reconstruction. From 1 January 1989 to 31 July 1995, 173 patients with carcinoma of the esophagus were operated in our institution. Transhiatal esophageal dissection was performed in 133 patients; 40 patients underwent transthoracic en bloc resection. The 30-day mortality rate was 7.5% (13 patients). Postoperative fibrotic stenosis of the cervical anastomosis requiring dilatation occurred in 36.4% (63 patients) 6–12 weeks after operation. Fibrotic stenosis of the cervical anastomosis did not develop in 97 patients. There was a significant difference concerning the incidence of anastomotic leaks within both groups: whereas in 23.8% of the 63 patients who developed a fibrotic stricture of the cervical anastomosis an anastomotic leak preceded this event (P<0.001), no anastomotic leak occurred in the group of 97 patients with normal healing of the cervical anastomosis. In addition, significantly (P<0.01) more patients (37.5%,n=23) with preexisting diabetes mellitus could be found among the 63 patients who developed a fibrotic stricture of the cervical anastomosis, in contrast to the 97 patients without anastomotic stenosis.