Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
Surg Endosc. 2013 Jan;27(1):61-6. doi: 10.1007/s00464-012-2407-0. Epub 2012 Jun 30.
Gastroparesis is a chronic disorder resulting in decreased quality of life. The gastric electrical stimulator (GES) is an alternative to gastrectomy in patients with medically refractory gastroparesis. The aim of this study was to analyze the outcomes of patients treated with the gastric stimulator versus patients treated with laparoscopic subtotal or total gastrectomy.
A retrospective chart review was performed of all patients who had surgical treatment of gastroparesis from January 2003 to January 2012. Postoperative outcomes were analyzed and symptoms were assessed with the Gastroparesis Cardinal Symptom Index (GCSI).
There were 103 patients: 72 patients (26 male/46 female) with a GES, implanted either with laparoscopy (n = 20) or mini-incision (n = 52), and 31 patients (9 male/22 female) who underwent laparoscopic subtotal (n = 27), total (n = 1), or completion gastrectomy (n = 3). Thirty-day morbidity rate (8.3% vs. 23%, p = 0.06) and in-hospital mortality rate (2.7% vs. 3%, p = 1.00) were similar for GES and gastrectomy. There were 19 failures (26%) in the group of GES patients; of these, 13 patients were switched to a subtotal gastrectomy for persistent symptoms (morbidity rate 7.7%, mortality 0). In total, 57% of patients were treated with GES while only 43% had final treatment with gastrectomy. Of the GES group, 63% rated their symptoms as improved versus 87% in the primary gastrectomy group (p = 0.02). The patients who were switched from GES to secondary laparoscopic gastrectomy had 100% symptom improvement. The median total GCSI score did not show a difference between the procedures (p = 0.12).
The gastric electrical stimulator is an effective treatment for medically refractory gastroparesis. Laparoscopic subtotal gastrectomy should also be considered as one of the primary surgical treatments for gastroparesis given the significantly higher rate of symptomatic improvement with acceptable morbidity and comparable mortality. Furthermore, the gastric stimulator patients who have no improvement of symptoms can be successfully treated by laparoscopic subtotal gastrectomy.
胃轻瘫是一种导致生活质量下降的慢性疾病。胃电刺激器（GES）是治疗药物难治性胃轻瘫患者胃切除术的替代方法。本研究的目的是分析接受胃刺激器治疗的患者与接受腹腔镜次全或全胃切除术治疗的患者的结局。
对 2003 年 1 月至 2012 年 1 月期间接受胃轻瘫手术治疗的所有患者进行回顾性病历分析。分析术后结果，并使用胃轻瘫关键症状指数（GCSI）评估症状。
共有 103 例患者：72 例（26 例男性/46 例女性）接受 GES 治疗，其中 20 例采用腹腔镜，52 例采用微创切口；31 例（9 例男性/22 例女性）接受腹腔镜次全（n = 27）、全（n = 1）或完成胃切除术（n = 3）。GES 组和胃切除术组的 30 天发病率（8.3% vs. 23%，p = 0.06）和住院死亡率（2.7% vs. 3%，p = 1.00）相似。GES 组有 19 例（26%）治疗失败；其中 13 例因持续症状转为次全胃切除术（发病率为 7.7%，死亡率为 0）。GES 组 57%的患者接受了 GES 治疗，而仅有 43%的患者最终接受了胃切除术治疗。GES 组中 63%的患者报告症状改善，而原发性胃切除术组中 87%的患者报告症状改善（p = 0.02）。从 GES 转为二次腹腔镜胃切除术的患者症状改善率为 100%。两种手术方式的总 GCSI 评分无差异（p = 0.12）。
胃电刺激器是治疗药物难治性胃轻瘫的有效方法。鉴于腹腔镜次全胃切除术的症状改善率显著更高，且发病率和死亡率可接受，也应将其作为胃轻瘫的主要治疗方法之一。此外，胃刺激器治疗后症状无改善的患者可成功行腹腔镜次全胃切除术。
