Service de chirurgie générale, digestive et endocrinienne, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
J Visc Surg. 2011 Oct;148(5):e327-35. doi: 10.1016/j.jviscsurg.2011.09.001. Epub 2011 Oct 22.
Functional disorders such as delayed gastric emptying, dumping syndrome or duodeno-gastro-esophageal reflux occur in half of the patients who undergo esophagectomy and gastric tube reconstruction for cancer. The potential role for pyloroplasty in the prevention of functional disorders is still debated. Antireflux fundoplication during esophagectomy can apparently reduce the reflux but at the cost of increasing the complexity of the operation; it is not widely used. The treatment of functional disorders arising after esophagectomy and gastroplasty for cancer is based mainly on dietary measures. Proton pump inhibitors have well documented efficiency and should be given routinely to prevent reflux complications. Erythromycin may prevent delayed gastric emptying, but it should be used with caution in patients with cardiovascular disorders. In the event of anastomotic stricture, endoscopic dilatation is usually efficient. Problems related to gastrointestinal functional disorders after esophageal resection and gastric tube reconstruction do not significantly impair long-term quality of life, which is mainly influenced by tumor recurrence.
功能性障碍，如胃排空延迟、倾倒综合征或十二指肠胃食管反流，在因癌症而行食管切除术和胃管重建的患者中约占一半。幽门成形术在预防功能性障碍方面的潜在作用仍存在争议。食管切除术中的抗反流胃底折叠术显然可以减少反流，但会增加手术的复杂性；因此并未广泛应用。癌症行食管切除术和胃成形术后出现的功能性障碍的治疗主要基于饮食措施。质子泵抑制剂的疗效有充分的文献记载，应常规使用以预防反流并发症。红霉素可预防胃排空延迟，但在心血管疾病患者中应谨慎使用。吻合口狭窄时，内镜扩张通常有效。食管切除和胃管重建后与胃肠道功能障碍相关的问题不会显著损害长期生活质量，因为肿瘤复发才是主要影响因素。
