Johansson J, Sloth M, Bajc M, Walther B
Department of Surgery, Lund University, Sweden.
Surgery. 1999 Mar;125(3):297-303.
The act of swallowing after gastric pull-up esophagectomy has not been thoroughly investigated. The aim of this study was to evaluate deglutition in the esophageal remnant and in the gastric conduit in patients who have undergone this operation.
The residual radionuclide activity was measured 15 seconds after a swallow in the esophageal remnant and at intervals up to a maximum of 120 minutes after a swallow in the gastric conduit. The scintigraphic rate of transit of a bolus in both areas was compared in patients who had anastomosis in the neck (n = 15) versus patients who had anastomosis in the chest (n = 19). Comparisons were also made between patients with and without symptoms of dysphagia. The scintigraphic measurements were also correlated with anastomotic diameters, measured with use of a volumetric balloon insufflation method, at 3, 6, and 12 months after operation.
There were no significant differences in esophageal residual radionuclide activity at 15 seconds after a swallow in the groups with anastomosis in the neck versus anastomosis in the chest, with 30% residual activity up to 12 months after operation in both groups (P = .24). In the patients as a whole the 50% gastric conduit emptying time of 44 to 61 minutes did not change during the first postoperative year (P = .12). There was no association between anastomotic diameter and residual activity in the remaining esophagus (P < .126). Moderate and severe dysphagia was reported in only a few patients, and there was no correlation between dysphagic symptoms and retention in the residual esophagus or slower emptying in the gastric conduit.
The amount of peristaltic activity in the remaining esophagus after esophagectomy with gastric replacement is unaffected by the level of the anastomosis. The gastric conduit empties slowly in all patients, and there is no correlation between the rate of emptying and either anastomotic diameter or symptoms of dysphagia.
胃上提食管切除术后的吞咽行为尚未得到充分研究。本研究的目的是评估接受该手术患者食管残端和胃管道的吞咽情况。
在吞咽后15秒测量食管残端的残余放射性核素活性，并在吞咽后间隔测量胃管道的残余放射性核素活性，最长间隔120分钟。比较颈部吻合的患者（n = 15）和胸部吻合的患者（n = 19）在这两个区域内团块的闪烁扫描传输速率。还对有吞咽困难症状和无吞咽困难症状的患者进行了比较。闪烁扫描测量结果也与术后3、6和12个月使用容积性球囊充气法测量的吻合口直径相关。
颈部吻合组和胸部吻合组在吞咽后15秒时食管残余放射性核素活性无显著差异，两组术后12个月内均有30%的残余活性（P = 0.24）。总体而言，患者的胃管道50%排空时间在术后第一年为44至61分钟，没有变化（P = 0.12）。吻合口直径与残余食管中的残余活性之间没有关联（P < 0.126）。只有少数患者报告有中度和重度吞咽困难，吞咽困难症状与残余食管中的潴留或胃管道排空缓慢之间没有相关性。
胃代食管切除术后残余食管的蠕动活动量不受吻合水平的影响。所有患者的胃管道排空都很缓慢，排空速率与吻合口直径或吞咽困难症状之间没有相关性。
