难治性颈段食管胃吻合口狭窄：处理方法和结局。

Refractory cervical esophagogastric anastomotic strictures: management and outcomes.

机构信息

University of Michigan Medical School, Section of Thoracic Surgery, Ann Arbor, MI 48109-5344, USA.

出版信息

J Thorac Cardiovasc Surg. 2011 Feb;141(2):444-8. doi: 10.1016/j.jtcvs.2010.10.011. Epub 2010 Dec 15.

DOI:10.1016/j.jtcvs.2010.10.011

PMID:21163501

Abstract

OBJECTIVE

For recalcitrant cervical esophagogastric anastomotic strictures after transhiatal esophagectomy, a protocol of self-dilatation was developed at the University of Michigan Medical Center, as previously described. This study was undertaken to determine the outcomes of this treatment.

METHODS

Self-dilatation was required in 158 (7.6%) of 2075 patients with cervical esophagogastric anastomotic strictures after transhiatal esophagectomy. An esophageal-specific survey evaluated the frequency and duration of dilatation, swallowing function, and satisfaction with treatment. The relationship among anastomotic leak, subsequent stricture, and the need for self-dilatation was assessed. A validated survey tool, the Short Form 36-item, version 2, was used to assess quality of life.

RESULTS

At the time of this study, 78 of 158 patients were alive; 34 (43%) participated in the esophageal-specific survey. Median duration of self-dilatation was 10 years. The majority were satisfied with their ability to eat. No adverse events were reported. All patients said they would use self-dilatation therapy again under similar circumstances. Of these patients, 20 (59%) responded to the Short Form 36-item, version 2. Compared with the general population, 55% and 70% of participants scored at or above the norm for physical health and mental health status, respectively. Patients who required self-dilatation were twice as likely to have a history of cervical esophagogastric anastomotic leak as those who did not require this therapy (P=.0002).

CONCLUSIONS

Refractory cervical esophagogastric anastomotic strictures are best managed initially with frequent outpatient dilatations, then transitioning to self-dilatation. Home use of Maloney dilators is a safe, well-tolerated, convenient, and cost-effective way to maintain comfortable swallowing. The effectiveness of self-dilatation therapy is reflected in this cohort's good quality of life and level of functioning.

摘要

目的

密歇根大学医学中心此前曾描述过，对于经食管裂孔食管切除术（transhiatal esophagectomy）后发生的难治性颈段食管胃吻合口狭窄，制定了自我扩张方案。本研究旨在确定该治疗方案的结果。

方法

在 2075 例经食管裂孔食管切除术后发生颈段食管胃吻合口狭窄的患者中，有 158 例（7.6%）需要进行自我扩张。一项专门针对食管的调查评估了扩张的频率和持续时间、吞咽功能以及对治疗的满意度。评估了吻合口漏、随后的狭窄和自我扩张需求之间的关系。使用经过验证的短表 36 项，第 2 版（Short Form 36-item，version 2）评估生活质量。

结果

在本研究进行时，158 例患者中有 78 例存活；34 例（43%）参与了专门针对食管的调查。自我扩张的中位持续时间为 10 年。大多数患者对自己的进食能力感到满意。没有报告不良事件。所有患者表示，如果再次出现类似情况，他们将再次使用自我扩张治疗。在这些患者中，20 例（59%）对短表 36 项，第 2 版做出了回应。与一般人群相比，55%和 70%的参与者在身体健康和心理健康状态方面的得分分别高于或等于常模。需要自我扩张治疗的患者发生颈段食管胃吻合口漏的可能性是无需该治疗的患者的两倍（P=.0002）。