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:Ivor Lewis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 lt;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 lt;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 lt;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 lt;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。
Citation：
FANG Qiang,REN Guangguo,HAN Yongtao,et al.. Prophylactic Treatment Measures against Delayed Gastric Emptying after Ivor Lewis Esophagectomy. West China Medical Journal, 2009, 24(10): 2532-2535. doi:
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Copyright © the editorial department of West China Medical Journal of West China Medical Publisher. All rights reserved
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PANEBIANCO V, FRANCIONI F, ANZIDEI M, et al. Magnetic resonancefluoroscopy as longterm followup examination in patients with narrow gastric tube reconstruction after radical esophagectomy[J]. Eur J Cardiothorac Surg, 2006,30(4):663-668.
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PALMES D, WEILINGHOFF M, COLOMBOBENKMANN M, et al. Effect of pyloric drainage procedures on gastric passage and bile reflux after esophagectomy with gastric conduit reconstruction[J]. Langenbecks Arch Surg, 2007,392(2):135-1341.
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URSCHEL J D, BLEWETT C J, YOUNG J E, et al. Pyloric drainage (pyloroplasty) or no drainage in gastric reconstruction after esophagectomy: a metaanalysis of randomized controlled trials[J]. Dig Surg, 2002,19(3):160-164.
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- 1. MATHISEN D J. Right Thoracoabdominal Approaches/Ivor LewisMcKeown Procedures[M]. Esophageal Surgery, Second Edition, 2002, Health Science Asia, Elsevier Science: 818-824.
- 2. YOICHI TABIRA, TOMONORI SAKAGUCHI, HIROSHI KUHARA, et al. The width of a gastric tube has no impact on outcome after esophagectomy[J]. Am J Surg, 2004,187:417-421.
- 3. 高宗人,赫捷主编.食管癌[M].北京:北京大学医学出版社,2008:187-188.
- 4. 陈克能, 师晓天, 冯瑞庆. 食管癌贲门癌的手术入路比较[J]. 中华胸心血管外科杂志,1998, 14: 232-233.
- 5. KIM J H, LEE H S, KIM M S, et al. Balloon dilatation of the pylorus for delayed gastric emptying after esophagectomy[J]. Eur J Cardiothorac Surg,2008,33(6):1105-1111.
- 6. PANEBIANCO V, FRANCIONI F, ANZIDEI M, et al. Magnetic resonancefluoroscopy as longterm followup examination in patients with narrow gastric tube reconstruction after radical esophagectomy[J]. Eur J Cardiothorac Surg, 2006,30(4):663-668.
- 7. PALMES D, WEILINGHOFF M, COLOMBOBENKMANN M, et al. Effect of pyloric drainage procedures on gastric passage and bile reflux after esophagectomy with gastric conduit reconstruction[J]. Langenbecks Arch Surg, 2007,392(2):135-1341.
- 8. URSCHEL J D, BLEWETT C J, YOUNG J E, et al. Pyloric drainage (pyloroplasty) or no drainage in gastric reconstruction after esophagectomy: a metaanalysis of randomized controlled trials[J]. Dig Surg, 2002,19(3):160-164.
