Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Dis Esophagus. 2011 May;24(4):205-10. doi: 10.1111/j.1442-2050.2010.01115.x. Epub 2010 Oct 11.
To determine if ischemic conditioning of the stomach improves the morbidity, mortality, and the anastomotic failure in gastroplasties with cervical anastomosis. Analysis of all patients with indication for cervical gastroplasty during the period of study. In all cases, ischemic conditioning was performed by selective embolization. Anastomotic failure, morbidity, and mortality rates were studied. Thirty-nine consecutive patients were included. Angiography and selective embolization of the left gastric, right gastric, and splenic arteries were performed. Surgery was performed 2 weeks later. Four patients did not have a complete embolization; median hospital stay after conditioning was 1.24 ± 0.6 days. In two patients, surgery could not be completed. Of the 33 remaining, 29 had a posterior mediastinic gastroplasty and four through the anterior mediastinum. The most common morbidity was respiratory. Five patients had a reoperation and the mortality was 6%. One case of anastomotic leak was found (3%). The mean hospital stay was 17.5 days. Preoperative embolization is a technique with acceptable morbidity and a short hospital stay. In our experience it can reduce the incidence of the morbidity, mortality, and anastomotic leak in gastroplasties with cervical anastomosis. Prospective studies will be necessary to demonstrate the validity of this approach.
为了确定胃缺血预处理是否能降低颈吻合胃成形术的发病率、死亡率和吻合口失败率。分析研究期间所有有颈胃成形术适应证的患者。所有病例均采用选择性栓塞进行缺血预处理。研究吻合口失败、发病率和死亡率。共纳入 39 例连续患者。进行了胃左动脉、胃右动脉和脾动脉的血管造影和选择性栓塞。2 周后进行手术。4 例患者未完全栓塞；预处理后中位住院时间为 1.24 ± 0.6 天。在 2 名患者中，手术无法完成。在其余 33 名患者中，29 名患者行后纵隔胃成形术，4 名患者行经前纵隔胃成形术。最常见的并发症是呼吸系统并发症。5 例患者需要再次手术，死亡率为 6%。吻合口漏 1 例（3%）。平均住院时间为 17.5 天。术前栓塞是一种具有可接受的发病率和较短住院时间的技术。根据我们的经验，它可以降低颈吻合胃成形术的发病率、死亡率和吻合口漏的发生率。需要前瞻性研究来证明这种方法的有效性。
