Clinical study of the effectiveness of pyloroplasty in reconstructive stric tube after esophagectom in esophageal carcinomas.

食管癌食管切除术后幽门成形术重建胃管的临床研究。导论：我们评估了幽门成形术的有效性，在全迷走神经切开术后常规增加幽门成形术以防止食物淤积，并在功能和营养阶段使用更大曲率胃管。样本与方法1992 ~ 1995年对67例患者行食管次全切除术和胃管重建术，其中幽门成形术组34例，非幽门成形术组33例。我们采用(1)摄食评分，(2)钡粒射血时间，(3)99mTc闪烁图，(4)75g OGTT功能评价，(1)快速翻转蛋白（RTP），(2)总淋巴细胞计数（TLC）， (3) ONODERA预后营养指数（PNI），(4)体重增减率，并定期检查。结果在功能评估中，幽门成形术明显减少了术后返流和主诉，尤其是胸前路线，但两组在胸骨后路线均较少出现症状，P组出现倾倒综合征数例。在胃排空试验中钡颗粒，99mtc -闪烁图。>=组(N)。在营养评价上，两组均有时间变化，但胃排空慢者有属于低营养状态的趋势，且社交回归慢于排空快者。结论重建胃管幽门成形术并非必要，其对进食生活质量的影响是有效的。本研究结果发表于第47届日本胸外科学会（JJATS）大会（1994年10月，千叶）、第48届日本胸外科学会（1995年10月，东京）、第6届国际食道疾病学会（ISDE）大会（1995年8月，东京），并收录于JJATS文集。

Clinical study of the effectiveness of pyloroplasty in reconstructive gastric tube after esophagectom in esophageal carcinomas.Introduction :We evaluated the effectiveness of pyloroplasty, that added conventionally after total vagotomy in purpose of preventing food stasis, with utilizing greater curvature gastric tube in both functional and nutrional phases.Sample and MethodsFrom 1992 to 1995, we had 67 cases (34 pyloroplasty group : (P), and 33 non-pyloroplastic group : (N) that were undergone subtotal esphagectomy and reconstructed gastric tube. We adopted (1) Food-taking scoreing, (2) barium granule ejection time, (3) 99mTc scintigram, (4) 75g OGTT in functional evaluation, and (1) Rapid turn-over protein (RTP), (2) Total lymphcyte count (TLC), (3) ONODERA's Prognostic nutritional index (PNI), (4) Increase and decrease rate of body weight, then we checked periodically.ResultsIn functional evaluation, the pyloroplasty was decreasing postoperative regurgitation and complaints especially in antethoracic route, though in retrosternal rout both groups showed fewer symptoms and in group (P), there werte several cases with dumping syndrome. In gastricemptying tests with barium granule, 99mTc-scintigram. there were seen as group (P)>=group (N). In nutritional evalusation, there were time-coursed changes in both groups, but there were some tendency that slow gastric emptying cases belonged to hyponutritional state and those social returning were slower than faster emptying cases.ConclusionIn conclusion, the pyloroplasty of reconstructive gastric tube is not essential, its affects to food-taking QOL effectively. The results of this study were presented in The 47th Jurnal of the Japanese Association for Thoracic Surgery (JJATS) congress (Oct.1994 CHIBA), The 48th JJATS (Oct.1995, TOKYO), The 6th International Society for Diseases of the Esophagus (ISDE) congress (Aug.1995 ITARY) and contributed to JJATS volume.