Koh Paul, Turnbull Geoffrey, Attia Elhamy, LeBrun Paul, Casson Alan G
Dalhousie University, Halifax, NS, Canada.
Eur J Cardiothorac Surg. 2004 Apr;25(4):480-5. doi: 10.1016/j.ejcts.2003.12.034.
The aim of this exploratory study was to investigate swallowing and function of the cervical esophagus after esophageal resection and reconstruction.
Nine patients (8 males, 1 female; median age 63 years), who underwent esophageal resection for adenocarcinoma, were studied from 6 to 40 months (median 18 months) postoperatively. For all patients, the upper gastrointestinal tract was reconstructed by transposing a narrow gastric tube through the posterior mediastinum to the left neck, where a semi-mechanical anastomosis to the cervical esophagus was performed. No patient had an anatomic obstruction to swallowing or stricture. The oral and pharyngeal phases of deglutition and function of the cervical esophagus were evaluated objectively by video barium swallow, esophagogastroscopy, velopharyngeal examination, manometry and balloon inflation in the cervical esophagus.
The median length of the cervical esophagus was 5 cm (range 3-7 cm). Mild reflux laryngopharyngitis was seen in all patients. Although all patients had an objective functional dysphagia measurement (American Speech-Language-Hearing Association) of 7 (normal), five reported subjective dysphagia. Four (of the five symptomatic) patients were found to have high pressure peristalitic activity (mean >100 mmHg) following balloon distention (10-30 ml) of the cervical esophagus, which was painful in three cases.
We conclude that in the absence of an anatomic cause for dysphagia after cervical esophagogastrostomy, a functional etiology may be explained by hypertensive peristalsis resulting from distention of the remaining cervical esophageal remnant. These findings may further explain anecdotal reports of the efficacy of empiric dilation after upper gastrointestinal reconstruction when no stricture is seen.
本探索性研究旨在调查食管切除重建术后颈段食管的吞咽及功能情况。
对9例因腺癌接受食管切除术的患者（8例男性，1例女性；中位年龄63岁）进行了术后6至40个月（中位时间18个月）的研究。所有患者均通过将狭窄胃管经后纵隔移位至左颈部进行上消化道重建，在颈部与颈段食管进行半机械吻合。所有患者均无吞咽解剖学梗阻或狭窄。通过视频吞钡造影、食管胃镜检查、腭咽检查、测压及颈段食管球囊扩张对吞咽的口腔和咽期以及颈段食管功能进行客观评估。
颈段食管的中位长度为5厘米（范围3 - 7厘米）。所有患者均出现轻度反流性喉咽炎。尽管所有患者的客观功能性吞咽困难测量值（美国言语语言听力协会标准）均为7（正常），但有5例报告有主观吞咽困难。在对颈段食管进行球囊扩张（10 - 30毫升）后，5例有症状的患者中有4例出现高压蠕动活动（平均>100毫米汞柱），其中3例伴有疼痛。
我们得出结论，在颈段食管胃吻合术后无吞咽困难解剖学原因的情况下，功能性病因可能是由于剩余颈段食管残端扩张导致的高血压蠕动。这些发现可能进一步解释了在上消化道重建后未见狭窄时经验性扩张疗效的轶事报道。
