Effect of pyloric drainage procedures on gastric passage and bile reflux after esophagectomy with gastric conduit reconstruction
Effect of pyloric drainage procedures on gastric passage and bile reflux after esophagectomy with gastric conduit reconstruction
复制标题
DOI：
10.1007/s00423-006-0119-4
复制
发表时间：
2007-03-01
影响因子：
2.3
通讯作者：
Bruewer, Matthias
中科院分区：
文献类型：
--
作者：
Palmes, Daniel;Weilinghoff, Matthias;Bruewer, Matthias
背景和目的食管胃吻合术和迷走神经切断术后是否需要幽门引流术（幽门成形术或幽门肌切开术）仍存在争议。虽然幽门引流可防止术后胃排空延迟，但也可促进胆汁反流进入食管。我们分析了幽门引流方法对食管癌术后胃出口梗阻和胆汁反流的潜在影响。材料与方法198例食管癌患者采用经胸食管切除胃管道重建术或幽门肌切开术（II组，n=118），幽门成形术（III组，n=34）或无幽门引流（I组，n=46）。通过放射学调查，吻合口瘘率，死亡率和胃食管反流的发生率在术后第一年内内镜进行了回顾性analysed.Results患者的人口统计学资料和手术方式的类型没有显着差异的三组术后胃肠道通道。三组患者的住院死亡率、吻合口瘘发生率、胃肠通道及术后住院时间无差异。然而，与没有幽门引流的患者相比，更多的幽门引流患者出现胆汁反流（I=0% vs II+III= 14.9%，p=0.069）和反流性食管炎（I=10.3% vs II+III= 34.5%，p < 0.05）。在多因素分析中，幽门引流和吻合口高度是独立的，是显着的危险因素与术后反流性食管炎。结论幽门引流食管切除术后，胃管道重建，应省略，因为它不改善胃排空，并可能有利于胆汁反流性食管炎。
Background and aims Controversy still exists about the need for pyloric drainage procedures (pyloroplasty or pyloromyotomy) after esophagectomy with esophagogastrostomy and vagotomy. Although pyloric drainage may prevent postoperative delayed gastric emptying, it may also promote bile reflux into the oesophagus. We analysed pyloric drainage methods for their potential effect on gastric outlet obstruction and bile reflux in patients undergoing esophagectomy.Materials and methods One hundred and ninety-eight patients with esophageal carcinoma were treated by transthoracal esophagectomy with gastric conduit reconstruction either with pyloromyotomy (group II, n=118), pyloroplasty (group III, n=34) or without pyloric drainage (group I, n=46) between January 2000 and December 2004. The postoperative gastrointestinal passage by radiological investigation, anastomotic leakage rate, mortality and incidence of gastroesophageal reflux by endoscopy within the first postoperative year were retrospectively analysed.Results Patient demographics and the types of surgical procedures did not differ between the three groups. There was no difference in hospital mortality, anastomotic leakage rate, gastrointestinal passage and postoperative hospital stay between the three groups. However, more patients with pyloric drainage showed bile reflux (I=0% vs II+III=14.9%, p=0.069) and reflux esophagitis (I=10.3% vs II+III=34.5%, p < 0.05) compared to patients without pyloric drainage. On the multivariate analysis, pyloric drainage and the anastomotic height were independent and were significant risk factors associated with postoperative reflux esophagitis.Conclusion Pyloric drainage after esophagectomy with gastric conduit reconstruction should be omitted because it does not improve gastric emptying and may favour biliary reflux esophagitis.