Roux-en-Y diversion for intractable reflux after esophagectomy.
Roux-en-Y diversion for intractable reflux after esophagectomy.
复制标题
Roux-en-Y 改道治疗食管切除术后顽固性反流。
DOI：
10.1016/j.athoracsur.2008.06.054
复制
发表时间：
2008
期刊：
影响因子：
--
通讯作者：
A. Duranceau
中科院分区：
文献类型：
--
作者：
X. D'Journo;Jocelyne Martin;L. Gaboury;P. Ferraro;A. Duranceau
背景反流性食管炎是食道切除和胃重建术后的一个重要问题。当混合反流损害食道残端或导致吸入问题时，适当的医疗处理是适当的。如果医疗管理失败，可以选择外科手术。这项研究报告了Roux-en-Y分流术在食道切除术后受衰弱反流并发症影响的患者中的结果。方法1990至2006年间，223例食道切除术患者中有4例因其食道残端或重复呼吸而需要手术矫正粘膜损伤。收集患者、临床、手术、组织病理学和术后资料。结果3例胸骨后重建的患者中有2例行腹股沟切除60 cm Roux-en-Y转移术。1例有明显反流性疾病和误吸的患者也有胃支气管瘘。胃间置去功能化，完成分期切除和Roux-en-Y改道重建。1例行椎前重建，行Roux-en-Y分流术，未行上颌骨切除。无一例死亡，发病率极低。2例患者无症状，2例好转。术后4名患者中，2名患者的内窥镜检查显示残留的食道黏膜正常；另外2名患者的食管壁上皮化生的柱状黏膜持续存在。结论完全十二指肠分流加60 cm胃空肠Roux-en-Y吻合术是纠正食管术后衰弱反流并发症的有效手术方法。反流症状得到纠正，粘膜得以愈合。手术入路受胃移植部位的影响。保护胃管的血管供应是手术的挑战。
BACKGROUNDReflux esophagitis is a significant problem after esophagectomy and gastric reconstruction. When mixed reflux damages the esophageal remnant or results in aspiration problems, appropriate medical management is in order. If medical management fails, a surgical option is available. This study reports results of a Roux-en-Y diversion in postesophagectomy patients affected by debilitating reflux complications.METHODSBetween 1990 and 2006, 4 of 223 esophagectomy patients required surgical correction for mucosal damage to their esophageal remnant or repeat aspirations. Patient, clinical, operative, histopathologic, and postoperative data were collected.RESULTSTwo of 3 patients with a substernal reconstruction underwent antrectomy with a 60-cm Roux-en-Y diversion. One patient with significant reflux disease and aspiration episodes also had a gastrobronchial fistula. The gastric interposition was defunctionalized, and a staged reconstruction with antrectomy and a Roux-en-Y diversion was completed. One patient with a prevertebral reconstruction had a Roux-en-Y diversion without antrectomy. There was no mortality and minimal morbidity. Two patients are asymptomatic and 2 are improved. Endoscopic assessment documented normal mucosa in the esophageal remnant for 2 of the 4 patients postoperatively; in 2 others, metaplastic columnar mucosa persisted. Active inflammation regressed in all 4 patients.CONCLUSIONSComplete duodenal diversion with a 60-cm Roux-en-Y gastrojejunostomy is an effective operation to correct debilitating reflux complications after esophagectomy. Reflux symptoms are corrected and the mucosa is allowed to heal. The surgical approach is influenced by the position of the gastric transplant. Protection of the vascular supply to the gastric tube is the challenge of the operation.