Mucosal Damage in the Esophageal Remnant After Esophagectomy and Gastric Transposition
Mucosal Damage in the Esophageal Remnant After Esophagectomy and Gastric Transposition
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DOI：
10.1097/sla.0b013e31818eec06
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发表时间：
2009-02-01
影响因子：
9
通讯作者：
Duranceau, Andre
中科院分区：
文献类型：
--
作者：
D'Journo, Xavier Benoit;Martin, Jocelyne;Duranceau, Andre
目的：根据右胸或左颈位置的食管胃造口术重建水平，评估食管残余物中粘膜损伤的发展情况。背景数据摘要：胃介入食管切除术创建了病理性食管反流的体内人体模型，具有长期反流病并发症的可能性。方法：随着时间的推移，通过症状、内窥镜检查和食管活检对 84 名食管切除患者进行了评估手术后残留。吻合位于右上胸部 (n = 36) 或左颈位置 (n = 48)。记录损伤的视觉量化、组织病理学细节和手术后的时间。结果：与颈部重建的 25 名患者 (53%) 相比，右胸部重建的 29 名患者 (81%) 出现反流症状 (P = 0.007)。 31 例（81%）胸部吻合患者和 22 例（46%）颈部吻合患者观察到可视化反流性食管炎（P = 0.006）。据记录，胸部吻合组的粘膜损伤和柱状内衬化生明显多于颈部吻合组。胸腔内吻合的所有粘膜损伤和柱状排列无化生进展的中位时间分别为13 +/- 3和20.5 +/- 6个月，颈部吻合的中位时间为22 +/- 6个月和40 +/- 8个月（P = 0.087）。多变量分析中纳入了影响化生发展的两个因素：胸腔内吻合术（P = 0.018）和先前存在 Barrett 食管（P = 0.064）。 结论：当食管切除术后使用胃移植物时，在食管残余物中观察到粘膜损伤的发生率很高，与重建水平无关。左颈吻合术有利于减少反流症状、减少可见损伤，并延缓粘膜损伤随时间的发展。
Objective: To assess development of mucosal damage in the esophageal remnant in regard to the level of the esophagogastrostomy reconstruction either in a right chest or in a left neck position.Summary Background Data: Esophagectomy with gastric interposition creates an in vivo human model of pathologic esophageal reflux with the potential for long-term reflux disease complications.Methods: Eighty-four esophagectomy patients were assessed over time by symptoms, endoscopy and biopsies of their esophageal remnant after the operation. The anastomosis was in the right upper chest (n = 36) or in a left cervical position (n = 48). Visual quantification of damage, details of histopathology, and time period since surgery were recorded.Results: Twenty-nine patients (81%) with a right chest reconstruction had reflux symptoms when compared with 25 patients (53%) with a neck reconstruction (P = 0.007). Visualized reflux esophagitis was observed in 31 patients (81%) with chest anastomoses and in 22 patients (46%) with cervical anastomoses (P = 0.006). Documented mucosal damage and columnar lined metaplasia were significantly more frequent in the chest anastomosis group than the cervical group. The median of all mucosal damage and columnar lined metaplastic-free evolution were 13 +/- 3 and 20.5 +/- 6 months for the intrathoracic anastomosis, and 22 +/- 6 months and 40 +/- 8 months for the cervical anastomosis (P = 0.087). Two factors affecting the development of metaplasia were included in the multivariate analysis: an intrathoracic anastomosis (P = 0.018) and the presence of a previous Barrett esophagus (P = 0.064).Conclusions: When a gastric transplant is used after esophagectomy, a high prevalence of mucosal damage is observed in the esophageal remnant independently of the level of reconstruction. A left cervical anastomosis favors less reflux symptoms, less visualized damage, and delays the development of mucosal damage over time.