Comparison of pyloric intervention strategies at the time of esophagectomy: is more better?
Comparison of pyloric intervention strategies at the time of esophagectomy: is more better?
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DOI：
10.1016/j.athoracsur.2014.02.046
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发表时间：
2014-06
影响因子：
4.6
通讯作者：
Crabtree, Traves D.
中科院分区：
文献类型：
--
作者：
Antonoff, Mara B.;Puri, Varun;Meyers, Bryan F.;Baumgartner, Kevin;Bell, Jennifer M.;Broderick, Stephen;Krupnick, A. Sasha;Kreisel, Daniel;Patterson, G. Alexander;Crabtree, Traves D.
关于幽门引流程序在食道切除胃管重建术后的作用仍存在争议。我们的目的是比较幽门引流策略对后续并发症风险的影响，这些并发症提示导管扩张，包括吸入和吻合口漏。对2007年1月4日至2012年4月4日间接受食道切除术的患者进行了回顾性研究。前瞻性收集的数据包括基线合并症、手术细节、住院病程和并发症。对于连续变量使用方差分析，对于分类变量使用X2检验进行统计比较。在研究期间，共进行了361例食道切除术，其中68例被排除在分析范围之外(对于之前的食管胃手术和/或良性疾病)。293例食道切除术中，不引流44例(15%)，幽门肌切开术197例(67%)，单纯扩张术8例(3%)，扩张术+幽门螺杆菌毒素A 44例(15%)。未行幽门介入治疗时误吸发生率较高(5/44例(11.4%)，6/249例(2.4%)，P=0.030)。吻合口漏18例(6.1%)，胃出口梗阻5例(1.7%)，组间比较差异有统计学意义。亚组分析表明，当将其与经胸食道切除术进行比较时，这些发现是持续的。发生与幽门成形术/幽门肌切开术直接相关的主要并发症2例(0.6%)，其中1例死亡(0.3%)。这些数据表明，在指数操作中忽略幽门干预会导致更频繁的误吸事件。与手术引流相比，扩张术加奥纳博林毒素A的联合应用提供了类似的并发症。未来需要进行前瞻性比较，以评估幽门介入治疗的短期效果以及长期后遗症，如倾倒综合征和胆汁返流。
Controversy remains regarding the role of pyloric drainage procedures following esophagectomy with gastric conduit reconstruction. We aimed to compare the effect of pyloric drainage strategies upon subsequent risk of complications suggestive of conduit distention, including aspiration and anastomotic leak. A retrospective study was conducted reviewing patients undergoing esophagectomy between 1/2007 – 4/2012. Prospectively collected data included baseline comorbidities, operative details, hospital course, and complications. Statistical comparisons were performed using ANOVA for continuous variables and X2 testing for categorical variables. There were 361 esophagectomies performed during the study period, 68 were excluded from analysis (for prior esophagogastric surgery and/or benign disease). Among 293 esophagectomies included, emptying procedures were performed as follows: 44 (15%) no drainage procedure, 197 (67%) pyloromyotomy/pyloroplasty, 8 (3%) dilation alone, 44 (15%) dilation + onabotulinumtoxinA. Aspiration occurred more frequently when no pyloric intervention was performed (5/44 [11.4%] versus 6/249 [2.4%], P = 0.030). The incidence of anastomotic leak (18 [6.1%]) and gastric outlet obstruction (5 [1.7%]) were statistically similar among groups. Subgroup analysis demonstrated persistence of these findings when limiting the comparison to transthoracic esophagectomies. Major complications directly related to pyloroplasty/pyloromyotomy occurred in 2 (0.6%) patients, including 1 (0.3%) mortality. These data suggest that omission of pyloric intervention at the index operation results in more frequent aspiration events. The combination of dilation plus onabotulinumtoxinA provided for a similar complication profile compared to surgical drainage. Future prospective comparisons are needed to evaluate these short-term effects of pyloric intervention as well as long-term sequelae such as dumping syndrome and bile reflux.
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DOI：
10.1016/j.jtcvs.2008.08.049
发表时间：
2009-03-01
影响因子：
6
作者：
Cerfolio, Robert James;Bryant, Ayesha S.;Eloubeidi, Mohamad A.
通讯作者：
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影响因子：
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作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
4.6
作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
Dudeck, Margaret A.