Laparoscopic and Endoscopic Pyloroplasty for Gastroparesis Results in Sustained Symptom Improvement
Laparoscopic and Endoscopic Pyloroplasty for Gastroparesis Results in Sustained Symptom Improvement
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DOI：
10.1007/s11605-011-1607-6
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发表时间：
2011-09-01
影响因子：
3.2
通讯作者：
Swanstroem, Lee L.
中科院分区：
文献类型：
--
作者：
Hibbard, Michael L.;Dunst, Christy M.;Swanstroem, Lee L.
胃轻瘫是一种慢性消化系统疾病，症状包括恶心、呕吐、腹胀和腹痛，导致生活质量下降。越来越多的外科医生被要求治疗胃轻瘫患者，因为由于许多促动力剂的安全性问题，医疗选择变得有限。手术选择包括胃刺激器植入术、胃次全切除术和幽门成形术。本文回顾性分析了2007年1月至2010年9月期间28例单纯行微创幽门成形术治疗成人胃轻瘫患者的资料。对26例患者行腹腔镜下Heineke-Mikulicz幽门成形术前后症状严重程度评分（SSS）、胃排空造影（GES）和药物使用情况进行回顾性分析。在2例患者中使用了腹腔镜辅助的柔性经口内镜环形吻合器幽门成形术。促动力剂的使用从89%显著降低至14%（p = < 0.0001）。平均GES T1/2从320分钟降至112分钟（p = 0.001），并在71%时恢复正常。在1个月时，恶心（p = < 0.0001）、呕吐（p = < 0.0001）、腹胀（p = 0.0023）、腹痛（p = < 0.0001）和胃食管反流病（GERD）症状（p = 0.0143）的SSS显著改善。恶心（p = < 0.0001）、呕吐（p =<0.0001）、腹胀（p = 0.0004）、腹痛（p = 0.0001）和GERD症状（p = 0.013）在3个月时持续显著改善。平均住院时间为3.71天。总的来说，83%的患者在1个月的随访中表示他们看到了改善。微创幽门成形术为胃轻瘫患者提供了极好的结局，应该被视为与饮食和药物一起沿着的主要治疗，因为它是有效的，并且不会消除将来对难治性疾病的额外手术选择。随着技术的进步，完全内镜幽门成形术可能是一种侵入性较小的选择。
Gastroparesis is a chronic digestive disorder with symptoms of nausea, vomiting, bloating, and abdominal pain resulting in a poor quality of life. Surgeons are increasingly asked to treat patients with gastroparesis as medical options have become limited due to safety concerns of many prokinetics. Surgical options include gastric stimulator implantation, sub-total gastrectomy, and pyloroplasty. We report our experience with minimally invasive pyloroplasty as sole surgical treatment for adult gastroparesis.A retrospective review of prospectively collected data of 28 patients who underwent minimally invasive pyloroplasty alone as treatment for gastroparesis from Jan 2007 to Sept 2010. Pre- and postoperative symptom severity score (SSS), gastric emptying scintigraphy (GES), and medication use were reviewed.A laparoscopic Heineke-Mikulicz pyloroplasty was performed in 26 patients. A laparoscopic assisted, flexible trans-oral endoscopic circular stapled pyloroplasty was used in two patients. Prokinetic use was significantly reduced from 89% to 14% (p = < 0.0001). The mean GES T1/2 decreased from 320 to 112 min (p = 0.001) and normalized in 71%. Significant improvements in the SSS were seen at 1 month for nausea (p = < 0.0001), vomiting (p = < 0.0001), bloating (p = 0.0023), abdominal pain (p = < 0.0001), and gastroesophageal reflux disease (GERD) symptoms (p = 0.0143). Significant improvement persisted at 3 months for nausea (p = < 0.0001), vomiting (p = < 0.0001), bloating (p = 0.0004), abdominal pain (p = 0.0001) and GERD symptoms (p = 0.013). The average length of stay was 3.71 days. Overall, 83% of patients' indicated that they saw improvement at 1 month follow-up.Minimally invasive pyloroplasty provides excellent outcomes for patients with gastroparesis and should be considered as a primary treatment along with diet and medications as it is effective and does not eliminate the option for additional surgical options in the future for refractory disease. With technological advancements, a totally endoscopic pyloroplasty may be a less invasive option.