Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Ann Surg Oncol. 2013 Oct;20(11):3655-61. doi: 10.1245/s10434-013-3041-3. Epub 2013 Jun 6.
Reflux frequently occurs after a gastric conduit has replaced the resected esophagus. In this Swedish population-based cohort study, the potential antireflux effects of using cervical anastomosis, intrathoracic antireflux anastomosis, or pyloric drainage, and a risk of dysphagia due to cervical anastomosis and intrathoracic antireflux anastomosis were studied.
Patients undergoing esophagectomy with gastric conduit reconstruction in 2001-2005 were included. Reflux symptoms and dysphagia were assessed 6 months and 3 years postoperatively using a validated questionnaire (EORTC QLQ-OES18). The study exposures were cervical anastomosis, antireflux anastomosis, and pyloric drainage procedure. Multivariable logistic regression and propensity-adjusted analyses based on multinomial logistic regression estimated odds ratios (OR) with 95 % confidence intervals (CI), adjusted for potential confounding.
A total of 304 patients were included in the study. Adjusted ORs for reflux symptoms were 0.9 (95 % CI 0.3-2.2) for patients with a cervical anastomosis compared to patients with an intrathoracic anastomosis, 0.9 (95 % CI 0.4-2.0) for patients with an antireflux anastomosis versus patients with a conventional anastomosis, and 1.5 (95 % CI 0.9-2.6) for patients after pyloric drainage versus patients without such a pyloric drainage procedure. Dysphagia was not statistically significantly increased after cervical anastomosis or antireflux anastomosis. ORs were virtually similar 3 years after surgery. No interactions were identified. The propensity analyses rendered similar results as the logistic regression models, except for a possibly increased dysphagia with a cervical anastomosis.
Cervical anastomosis, antireflux anastomosis, and pyloric drainage do not seem to prevent reflux symptoms 6 months or 3 years after esophagectomy for cancer with a gastric conduit.
胃管重建后，常会出现反流。在这项基于瑞典人群的队列研究中，研究了使用颈部吻合、胸腔内抗反流吻合或幽门引流术的潜在抗反流作用，以及颈部吻合和胸腔内抗反流吻合导致吞咽困难的风险。
纳入 2001-2005 年接受食管切除术和胃管重建的患者。术后 6 个月和 3 年，使用经过验证的问卷（EORTC QLQ-OES18）评估反流症状和吞咽困难。研究暴露因素为颈部吻合、抗反流吻合和幽门引流术。多变量逻辑回归和基于多项逻辑回归的倾向调整分析，基于多项逻辑回归估计了比值比（OR）及其 95%置信区间（CI），并调整了潜在混杂因素。
共纳入 304 例患者。与胸腔内吻合相比，颈部吻合患者的反流症状调整后 OR 为 0.9（95%CI 0.3-2.2），抗反流吻合患者的 OR 为 0.9（95%CI 0.4-2.0），与常规吻合相比，幽门引流患者的 OR 为 1.5（95%CI 0.9-2.6）。与无幽门引流术相比，颈部吻合或抗反流吻合术后吞咽困难并未显著增加。术后 3 年 OR 几乎相似。未发现交互作用。倾向分析得出的结果与逻辑回归模型相似，除了颈部吻合后吞咽困难可能增加。
在胃管重建治疗癌症的食管癌手术后 6 个月或 3 年，颈部吻合、抗反流吻合和幽门引流术似乎并不能预防反流症状。
