Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing city, 400042, People's Republic of China.
World J Surg. 2010 Dec;34(12):2837-43. doi: 10.1007/s00268-010-0766-z.
This study was designed to evaluate the clinical efficacy of pyloric digital fracture for the prevention of early delayed gastric emptying (DGE) after high-level esophagogastrostomy.
From January 2004 to March 2009, we sequentially enrolled 78 patients after esophagogastrostomy: 48 patients with pyloric digital fracture (DF group) and 30 patients without any drainage procedure (non-DF group). Intraoperative manometric study was performed in 48 patients of the DF group. Postoperative evaluation was performed, including symptomatic questionnaire, radiographic study, and gastric scintigraphy.
Intraoperative manometric study revealed that basal pyloric pressure and peak pressure of pylorus in phase III of the migrating motor complex increased significantly after gastric conduit was made and anastomosed, but decreased appreciably following digital fracture. Compared with the peak pressure of IPPW before digital fracture (88.52 ± 19.88 mmHg), it appreciably decreased following digital fracture (40.45 ± 13.52 mmHg). Occurrences of IPPW (in 10 min) and duration time of each occurrence (s) had similar trends for before and after digital fracture (11.5 ± 4.5 vs. 5.0 ± 3.5 and 7.0 ± 2.0 vs. 3.0 ± 1.0, respectively). Postoperative evaluation demonstrated that early DGE occurred in four patients in the non-DF group (13.3%), and there was no DGE patient in the DF group. There was significant difference regarding gastric scores between the DF group and the non-DF group (10.5 ± 3.4 vs. 16.7 ± 3.8, t = 2.8271, P < 0.05). Gastric scintigraphy revealed that either semi-emptying-time or percent of retention at 4 h of the DF group was significantly lower than that of the non-DF group.
Pyloric digital fracture can prevent early DGE after high-level esophagogastrostomy efficaciously and conveniently.
本研究旨在评估幽门数字成形术预防高位食管胃吻合术后早期延迟性胃排空（DGE）的临床疗效。
2004 年 1 月至 2009 年 3 月，我们连续纳入 78 例食管胃吻合术后患者：48 例行幽门数字成形术（DF 组），30 例未行任何引流术（非 DF 组）。DF 组 48 例行术中测压研究。术后评估包括症状问卷调查、影像学研究和胃闪烁扫描。
术中测压研究显示，胃管制成并吻合后，基础幽门压和移行性运动复合波 III 期幽门峰压显著升高，但行数字成形术后明显下降。与数字成形术前 IPPW 峰压（88.52±19.88mmHg）相比，数字成形术后明显下降（40.45±13.52mmHg）。IPPW（10min 内）的发生次数和每次发生的持续时间（s）在数字成形术前和术后有相似的趋势（11.5±4.5 比 5.0±3.5 和 7.0±2.0 比 3.0±1.0）。术后评估显示，非 DF 组有 4 例（13.3%）发生早期 DGE，DF 组无 DGE 患者。DF 组和非 DF 组的胃评分有显著差异（10.5±3.4 比 16.7±3.8，t=2.8271，P<0.05）。胃闪烁扫描显示，DF 组的半排空时间或 4h 时的潴留率明显低于非 DF 组。
幽门数字成形术可有效、方便地预防高位食管胃吻合术后早期 DGE。
