Aly A, Jamieson G G
University of Adelaide Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia.
Br J Surg. 2004 Feb;91(2):137-41. doi: 10.1002/bjs.4508.
Reflux of gastric and duodenal content after oesophagectomy with gastric conduit reconstruction is a common problem and largely considered an inevitable consequence of surgery. Cervical burning and regurgitation, often more pronounced when supine, can be troublesome and even disabling, interfering substantially with quality of life. The aim of this study was to identify the factors contributing to reflux after oesophagectomy and evaluate measures to prevent or control it.
A Medline search using the terms 'gastro-oesophageal reflux', 'oesophagectomy' and 'antireflux surgery' was conducted. Additional references and search pathways were sourced from the bibliographies of articles located.
Reflux after oesophagectomy is a significant problem, with both clinical and pathological consequences. Simple measures to facilitate gastric emptying, such as creating a gastric tube, performing a pyloric drainage procedure and using gastric motility agents, may produce a reduction in symptoms but do not alone control reflux itself. A variety of surgical reconstructions have been used, many of which are either difficult to fashion or not suitable when a radical resection has been performed. A modified fundoplication at the anastomosis seems to be the simplest technique and may be relatively effective in controlling symptoms. The impact of strategies to reduce reflux on quality of life and on pathological sequelae of reflux in the oesophageal remnant remains to be evaluated.
食管切除并采用胃代食管重建术后，胃和十二指肠内容物反流是一个常见问题，在很大程度上被认为是手术不可避免的后果。颈部烧灼感和反流，在仰卧位时往往更为明显，可能会带来麻烦甚至使人丧失活动能力，严重影响生活质量。本研究的目的是确定食管切除术后导致反流的因素，并评估预防或控制反流的措施。
使用“胃食管反流”“食管切除术”和“抗反流手术”等术语在医学文献数据库（Medline）中进行检索。其他参考文献和检索途径来自所找到文章的参考文献目录。
食管切除术后的反流是一个重大问题，具有临床和病理后果。促进胃排空的简单措施，如制作胃管、进行幽门引流手术和使用促胃动力药物，可能会减轻症状，但不能单独控制反流本身。已经采用了多种手术重建方法，其中许多在进行根治性切除时要么难以实施，要么不合适。在吻合口处进行改良胃底折叠术似乎是最简单的技术，可能在控制症状方面相对有效。减少反流的策略对生活质量和食管残余部分反流的病理后遗症的影响仍有待评估。
