Csendes Attila, Burdiles Patricio, Braghetto Italo, Korn Owen, Díaz Juan Carlos, Rojas Jorge
Department of Surgery, José Joaquín Aguirre Hospital, University of Chile, Santos Dumont 999, Santiago, Chile.
World J Surg. 2002 May;26(5):566-76. doi: 10.1007/s00268-001-0269-z. Epub 2002 Mar 1.
The usual surgical treatment for patients with Barrett's esophagus (BE) is a classic Nissen fundoplication or posterior gastropexy with cardial calibration. However, some surgical reports as well as our experience suggest that the rate of failure of the Nissen fundoplication or Hill's posterior gastropexy in patients with BE is significantly higher than in those with reflux esophagitis without BE, probably due in part to the persistence of duodenal reflux into the esophagus. Our aim was to determine the late subjective and objective results of an operation consisting in "acid suppression" (vagotomy-partial gastrectomy) and "duodenal diversion" (Roux-en-Y anastomosis) as a primary surgical procedure for patients with BE. Altogether, 210 patients were subjected to this technique. It consisted in a primary operation in 142 patients and revision surgery in 68. They underwent complete clinical, radiologic, endoscopic, histologic, and manometric studies. In some cases 24-hour pH studies, Bilitec studies, gastric emptying, and gastric acid secretion evaluations were performed. There were two deaths (0.95%), and postoperative morbidity was low (5.3%). The late mean follow-up (58 months) for 146 patients who completed a follow-up longer than 24 months showed Visick I and II grades in 91.1% of the cases. In 14.9% of the cases 24-hour pH monitoring showed excessive acid reflux 1 year after surgery. No dysplasia or adenocarcinoma has appeared up to now. Functional studies showed significant alleviation of lower esophageal sphincter (LES) incompetence, with abolition of duodenal reflux into the esophagus. Gastric emptying of solids was normal, and basal and peak gastric acid output remained at a low level 8 to 10 years after surgery. In patients with BE, with severe damage of the LES and esophageal peristalsis, the "suppression diversion" operation completely abolishes the reflux of injurious components of the refluxate and improves sphincter competence. This effect is permanent and avoids the appearance of dysplasia or adenocarcinoma.
巴雷特食管（BE）患者的常规手术治疗是经典的nissen胃底折叠术或贲门校准的后胃固定术。然而，一些手术报告以及我们的经验表明，BE患者中nissen胃底折叠术或希尔后胃固定术的失败率显著高于无BE的反流性食管炎患者，这可能部分归因于十二指肠反流持续进入食管。我们的目的是确定作为BE患者主要手术方式的“抑酸”（迷走神经切断术-部分胃切除术）和“十二指肠改道”（Roux-en-Y吻合术）手术的晚期主观和客观结果。共有210例患者接受了该技术治疗。其中142例患者接受了初次手术，68例接受了翻修手术。他们接受了全面的临床、放射学、内镜、组织学和测压研究。在某些情况下，还进行了24小时pH值研究、Bilitec研究、胃排空和胃酸分泌评估。有2例死亡（0.95%），术后发病率较低（5.3%）。对146例随访时间超过24个月的患者进行的晚期平均随访（58个月）显示，91.1%的病例为Visick I级和II级。在14.9%的病例中，24小时pH监测显示术后1年存在过度酸反流。截至目前，未出现发育异常或腺癌。功能研究表明，食管下括约肌（LES）功能不全得到显著缓解，十二指肠反流进入食管的情况消失。固体食物的胃排空正常，术后8至10年基础胃酸分泌量和胃酸分泌峰值仍处于较低水平。对于LES和食管蠕动严重受损的BE患者，“抑酸改道”手术完全消除了反流物中有害成分的反流，并提高了括约肌功能。这种效果是永久性的，可避免发育异常或腺癌的出现。
