Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Surgery. 2014 Aug;156(2):290-7. doi: 10.1016/j.surg.2014.03.014. Epub 2014 Mar 14.
Delayed gastric emptying (DGE) following esophagectomy is a debilitating complication. Rarely, failure of postoperative endoscopic therapy may necessitate rescue pyloroplasty (rPP).
We conducted a retrospective, single-institution review of rPP for post-esophagectomy DGE from 2000 to 2013. Pre- and postoperative symptoms and pharmacologic use were examined. "Successful" rPP was defined as resolution of symptoms and pharmacologic requirements postoperatively. Quality of life (QoL) was evaluated by Short Form-12 and study-specific questionnaires.
Thirteen patients underwent open transabdominal rescue Heineke-Mikulicz pyloroplasty. Between esophagectomy and rPP, average interval weight loss was 19 ± 15 lb over 13 months (range, 3-22). Patients underwent 3.4 ± 1.0 preoperative endoscopic balloon dilation (EBD) attempts, with 7 (54%) receiving endoscopic intrapyloric botulinum toxin (IPB) injections. Median follow-up was 12 months (range, 4-23). After rPP, the incidence of nausea, vomiting, bloating, prokinetic use, and total parenteral nutrition/total enteral nutrition dependence decreased (all P < .01). All patients gained weight; 2 developed biliary reflux. Nine of 13 patients were identified as rPP successes; predictors of rPP failure were American Society of Anesthesiologists grade 3 (P = .02), greater number of EBD attempts (P = .02), longer time to rPP (P = .03), and fewer IPB injections (P = .03). QoL assessment revealed general satisfaction with postoperative outcomes and excellent physical and mental functioning.
rPP for post-esophagectomy DGE is well-tolerated, results in improvements in symptoms and pharmacologic dependence, and satisfactorily preserves QoL.
食管切除术后胃排空延迟（DGE）是一种使人虚弱的并发症。在极少数情况下，术后内镜治疗的失败可能需要进行抢救性幽门成形术（rPP）。
我们对 2000 年至 2013 年因术后 DGE 而行 rPP 的患者进行了回顾性、单机构研究。检查了术前和术后症状以及药物使用情况。“成功”的 rPP 定义为术后症状和药物需求得到解决。通过简短形式 12 项健康调查量表和研究特定问卷评估生活质量（QoL）。
13 例患者接受了开腹经腹腔抢救性 Heineke-Mikulicz 幽门成形术。在食管切除术和 rPP 之间，平均体重减轻 19 ± 15 磅，历时 13 个月（范围，3-22）。患者接受了 3.4 ± 1.0 次术前内镜球囊扩张（EBD）尝试，其中 7 例（54%）接受了内镜幽门内肉毒杆菌毒素（IPB）注射。中位随访时间为 12 个月（范围，4-23）。rPP 后，恶心、呕吐、腹胀、促动力药物使用和全胃肠外营养/全肠内营养依赖的发生率降低（均 P <.01）。所有患者体重增加；2 例出现胆汁反流。13 例患者中有 9 例被认为是 rPP 成功；rPP 失败的预测因素为美国麻醉医师协会（ASA）分级 3 级（P =.02）、EBD 尝试次数更多（P =.02）、rPP 时间更长（P =.03）和 IPB 注射次数更少（P =.03）。QoL 评估显示，患者对术后结果总体满意，身体和精神功能良好。
rPP 治疗食管切除术后 DGE 耐受性良好，可改善症状和药物依赖，并令人满意地保留 QoL。
