Section of Thoracic Surgery, University of Michigan Health System, Ann Arbor, Michigan 48109, USA.
Ann Thorac Surg. 2010 Apr;89(4):1015-21; discussion 1022-3. doi: 10.1016/j.athoracsur.2009.10.052.
Esophagectomy is indicated occasionally for the treatment of patients with refractory gastroesophageal reflux disease (GERD) or recurrent hiatus hernia. The purpose of this study was to evaluate the impact of previous gastroesophageal operations on outcomes after esophagectomy for recurrent GERD or hiatus hernia.
Using a prospectively accumulated database, a retrospective review was performed to identify patients undergoing esophagectomy for complicated GERD or hiatus hernia. Mortality, perioperative and functional outcomes, and need for reoperation were evaluated, assessing esophagectomy patients who had undergone prior operations for GERD or hiatus hernia.
Of 258 patients with GERD or hiatus hernia undergoing esophagectomy, 104 had undergone a previous operation, with a median interval to esophagectomy of 28 months. Transhiatal resection was accomplished in fewer patients undergoing reoperation (87 of 104 versus 151 of 154; p<0.005). A gastric conduit was used as an esophageal replacement in fewer patients with previous operation(s) (89 of 104 versus 150 of 154; p<0.005). Esophagectomy patients with a history of prior gastroesophageal surgery, as compared with those without, sustained more blood loss and were more likely to require reoperation, and fewer reported good to excellent swallowing function (p<0.05). There was no difference in the occurrence of anastomotic leak.
Esophagectomy in patients who have undergone prior operations for either GERD or hiatus hernia can be accomplished without thoracotomy and with satisfactory intermediate-term quality of life. Such patients should be evaluated and prepared for the use of alternative conduits should the remobilized stomach prove to be an unsatisfactory esophageal substitute at the time of esophagectomy.
食管切除术偶尔用于治疗难治性胃食管反流病（GERD）或复发性食管裂孔疝患者。本研究旨在评估先前的胃食管手术对复发性 GERD 或食管裂孔疝患者行食管切除术的结果的影响。
使用前瞻性累积数据库，对接受食管切除术治疗复杂 GERD 或食管裂孔疝的患者进行回顾性分析。评估死亡率、围手术期和功能结果以及再次手术的需要，并评估既往接受过 GERD 或食管裂孔疝手术的食管切除术患者。
在 258 例接受 GERD 或食管裂孔疝食管切除术的患者中，有 104 例曾接受过先前的手术，食管切除术的中位间隔时间为 28 个月。再次手术的患者中经胸切除的比例较低（87 例与 151 例；p<0.005）。既往手术的患者中使用胃管作为食管替代物的比例较低（89 例与 150 例；p<0.005）。与无先前胃食管手术史的患者相比，有先前手术史的食管切除术患者失血更多，更有可能需要再次手术，且较少报告良好至极好的吞咽功能（p<0.05）。吻合口漏的发生率无差异。
对于曾接受过 GERD 或食管裂孔疝手术的患者，行非开胸食管切除术并可获得满意的中期生活质量。对于此类患者，应在术前评估并准备使用替代移植物，以防在食管切除时发现再动员的胃不能作为满意的食管替代物。
