Prevention of Delayed Gastric Emptying After Esophagectomy: A Single Center's Experience With Botulinum Toxin
Prevention of Delayed Gastric Emptying After Esophagectomy: A Single Center's Experience With Botulinum Toxin
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DOI：
10.1016/j.athoracsur.2009.01.075
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发表时间：
2009-06-01
影响因子：
4.6
通讯作者：
Fabian, Thomas
中科院分区：
文献类型：
--
作者：
Martin, Jeremiah T.;Federico, John A.;Fabian, Thomas
背景。食管切除术后胃排空受损会导致严重的发病率和恢复延迟。预防这种情况的传统措施包括幽门肌切开术和幽门成形术。这些手术与已知的并发症有关，并且并不总能防止胃排空延迟。幽门内注射肉毒毒素可能是食管切除术后避免幽门梗阻的另一种方法。方法。患者数据是在单一机构以前瞻性方式收集的。 26 个月期间（2005 年 10 月至 2008 年 1 月），48 名患者在食管切除术期间接受了幽门内肉毒毒素注射。三名患者因并发症而被排除在分析之外，这些并发症干扰了术后排空评估。对 45 名患者进行了胃排空延迟体征的临床评估。客观评估包括 15 名患者的吞咽困难评分、43 名患者的吞咽困难评分以及 15 名患者的核胃排空扫描。还对数据进行了审查，以寻找导致肺部并发症的误吸事件的证据。结果。 45 名患者中的 43 名 (96%) 在术后立即没有胃排空延迟的临床证据。四项钡研究被解释为胃排空延迟；然而，只有2名患者出现症状。这 2 名患者接受了幽门球囊扩张术，1 名患者的症状得到缓解。另外 3 名患者在最初表现良好（平均术后 3 个月）后出现“晚期”胃排空延迟，需要内镜干预。研究中未发现与肉毒毒素注射相关的并发症。结论。幽门内注射肉毒毒素是避免食管切除术后胃排空延迟的一种简单、安全、有效的方法。必要时，可通过内窥镜进行再次干预。 （Ann Thorac Surg 2009；87：1708-14）（C）2009 年，胸外科医师协会
Background. Impaired gastric emptying after esophagectomy contributes to significant morbidity and delayed recovery. Traditional measures to prevent this include pyloromyotomy and pyloroplasty. These procedures are associated with known complications and do not always prevent delayed gastric emptying. Intrapyloric botulinum toxin injection may be an alternative approach to avoiding pyloric obstruction after esophagectomy.Methods. Patient data were collected in a prospective fashion at a single institution. Forty-eight patients underwent intrapyloric botulinum toxin injection during esophagectomy during a 26-month period (October 2005 to January 2008). Three patients were excluded from analysis because of complications, which interfered with postoperative evaluation of emptying. Forty-five patients were evaluated clinically for signs of delayed gastric emptying. Objective assessment included a dysphagia score in 15, barium swallow in 43, and nuclear gastric emptying scans in 15 patients. The data were also reviewed for evidence of aspiration events leading to pulmonary complications.Results. Forty-three of 45 patients (96%) had no clinical evidence of delayed gastric emptying in the immediate postoperative period. Four barium studies were interpreted as delayed gastric emptying; however, only 2 patients were symptomatic. These 2 patients underwent balloon pyloric dilation, which resulted in resolution of symptoms in 1. Three additional patients exhibited "late" delayed gastric emptying after initially doing well (mean of 3 months postoperatively) and required endoscopic intervention. No complications were identified in the study related to botulinum toxin injection.Conclusions. Intrapyloric injection with botulinum toxin is a simple, safe, and effective means of avoiding delayed gastric emptying after esophagectomy. When necessary, reintervention may be performed endoscopically. (Ann Thorac Surg 2009; 87: 1708-14) (C) 2009 by The Society of Thoracic Surgeons