Mannell A, McKnight A, Esser J D
Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.
Br J Surg. 1990 Jan;77(1):57-9. doi: 10.1002/bjs.1800770120.
A prospective, randomized, controlled trial comparing clinical outcome and emptying of a solid meal from the retrosternal stomach, with and without pyloroplasty is described. Forty consecutive patients with oesophageal cancer undergoing retrosternal gastric reconstruction of the oesophagus were studied. In 20 patients the pylorus was left intact (group 1) and 20 patients underwent an Aust pyloroplasty (group 2). Nine patients in group 1 suffered postoperative symptoms of gastric stasis compared with only one patient in group 2 (P = 0.0106). Three patients in group 1 died from aspiration pneumonia before discharge from hospital. A gastric emptying test was performed on 24 patients between 1 and 3 months after surgery. By this time, most survivors had recovered from symptoms attributed to gastric stasis and no significant difference in gastric emptying could be demonstrated between the two groups. Selection of patients, a wide range of emptying times and improvement in gastric emptying on follow-up may explain the lack of correlation between postoperative symptomatology and the gastric half-emptying times. A pyloroplasty is advised to prevent the potentially lethal effects of gastric stasis in the early postoperative period following retrosternal reconstruction of the oesophagus.
本文描述了一项前瞻性、随机对照试验，比较了行与不行幽门成形术时，胸骨后胃固体食物排空情况及临床结局。对40例连续接受胸骨后胃食管重建术的食管癌患者进行了研究。20例患者幽门保持完整（第1组），20例患者接受奥斯特（Aust）幽门成形术（第2组）。第1组9例患者术后出现胃潴留症状，而第2组仅1例患者出现该症状（P = 0.0106）。第1组3例患者在出院前死于吸入性肺炎。术后1至3个月对24例患者进行了胃排空试验。此时，大多数幸存者已从胃潴留相关症状中恢复，两组间胃排空无显著差异。患者的选择、广泛的排空时间范围以及随访时胃排空的改善，可能解释了术后症状与胃半排空时间之间缺乏相关性的原因。建议行幽门成形术，以预防食管胸骨后重建术后早期胃潴留的潜在致命影响。
