IVOR LEWIS食管切除术后胃延迟排空的防治对策

目的：总结食管胸段癌Ivor Lewis食管切除术后胃延迟排空的防治对策。方法：回顾性分析我院3100例食管胸中下段癌行Ivor Lewis食管切除术后胃延迟排空的发生率。根据术中采取不同措施分为：A组（裂孔切开）和B组（不作裂孔切开）,P组（幽门括约肌捏断）和N组（不作幽门处理）,管胃组（管胃替代食管）和全胃组（全胃代食管）,PM组（幽门括约肌捏断）、PN组（不作幽门处理）和PP组（幽门成形）。比较不同处理方式前后胃延迟排空的发生率。结果：IvorLewis食管切除术后胃延迟排空的总的发生率为13.8%（427/3100）。术中裂孔扩大后胃延迟排空的发生率从32%（A组）降至21%（B组）（P〈0.05）;术中同时行幽门括约肌捏断后胃延迟排空的发生率从21%（N组）降至9%（P组）（P〈0.05）;采用管胃替代食管后胃延迟排空的发生率从19.5%（全胃组）降至8.3%（管胃组）（P〈0.05）;管胃组中PN组胃延迟排空的发生率为15%,PP组为8%,行幽门成形（PP组）后降至2%（P〈0.05）。结论：胃延迟排空是Ivor Lewis食管切除术后主要的并发症,术中扩大食管裂孔、管胃替代食管和幽门成形可有效防治术后胃延迟排空的发生。

Prophylactic Treatment Measures against Delayed Gastric Emptying after Ivor Lewis Esophagectomy

Objective：Summarize the prophylactic treatment measures against delayed gastric emptying （DGE） after Ivor lewis esophagectomy for middle or lower thoracic esophageal cancer.Methods：The incidences of DGE after Ivor lewis esophagectomy were retrospectively analyzed in 3100 patients with middle or lower thoracic esophageal cancer.According to the different intraoperative techniques the patients were divided：group without （A,n=592） and with （B,n=253） dissecting esophageal hiatus;group with （P,n=65） and without （N,n=253） disrupting the pyloric muscles using the hand;group gastric tube （n=2091） and whole gastric （n=318） as the esophageal substitute;group PM （n=1990） with disrupting the pyloric muscles,PN （n=101） without managing the pyloric muscles and PP （n=52） with pyloroplasty.The incidences of DGE were compared between groups.Results：The DGE was seen in 13.8%（427/3100） patients after Ivor lewis esophagectomy.The differences were significantly different （P〈0.05） between patients in group A （32%） and B （21%）,and group P （9%） and N （21%）,and group gastric tube （8.3%） and whole gastric （19.5%）,and group PM （8%）,PN （15%） and PP （2%）.Conclusion：The DGE is the main postoperative complication after Ivor lewis esophagectomy.Intraoperative enlarging esophageal hiatus,and gastric tube as the esophageal substitute and pyloroplasty can prevent delayed gastric emptying after esophageal substitution.