Greene Christina L, DeMeester Steven R, Augustin Florian, Worrell Stephanie G, Oh Daniel S, Hagen Jeffrey A, DeMeester Tom R
Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
Ann Thorac Surg. 2014 Nov;98(5):1713-9; discussion 1719-20. doi: 10.1016/j.athoracsur.2014.06.088. Epub 2014 Sep 23.
The long-term outcome after colon interposition for esophageal reconstruction is not well documented. Our objective was to assess quality of life and alimentary satisfaction 10 or more years after colon interposition.
Patients who had an esophagectomy that was reconstructed using a colon interposition before April 2003 were identified. Symptoms, alimentary satisfaction, and quality of life were assessed by telephone interview and questionnaires.
We identified 79 surviving patients, and follow-up was obtained in 63 (80%). The indication for esophagectomy was cancer in 45 patients and benign disease in 18. Vagal-sparing esophagectomy was performed in 48% of patients, en bloc in 44%, and transhiatal in 8%. Median follow-up was 13 years (range, 10 to 38 years). The median Gastrointestinal Quality of Life Index score was 3 of 4 and results from the RAND 36-Item Short Form Health Survey (RAND Corp, Santa Monica, CA) were at or above the published normal means in all categories. Most patients were free of dysphagia (89%), regurgitation (84%), and heartburn (84%). The most common postprandial symptom was early satiety (40%). The body mass index was within normal reference ranges in 90% of patients. Follow-up esophagogastroduodenoscopy in 30 patients at a median of 6 years showed no Barrett's metaplasia in the residual esophagus. Seven patients had a reoperation for colon redundancy.
Long-term alimentary satisfaction and quality of life were excellent after colon interposition. Most patients were free of dysphagia and few needed revision for redundancy. These results should encourage the use of a colon interposition in patients expected to survive long-term after esophagectomy.
结肠代食管重建术后的长期结局尚无充分记录。我们的目的是评估结肠代食管术后10年或更长时间的生活质量和饮食满意度。
确定2003年4月前接受结肠代食管重建食管切除术的患者。通过电话访谈和问卷调查评估症状、饮食满意度和生活质量。
我们确定了79名存活患者，其中63名（80%）获得了随访。食管切除术的指征为45例患者为癌症，18例为良性疾病。48%的患者行保留迷走神经的食管切除术，44%的患者行整块切除，8%的患者行经裂孔切除。中位随访时间为13年（范围10至38年）。胃肠道生活质量指数评分中位数为4分中的3分，兰德36项简短健康调查（兰德公司，加利福尼亚州圣莫尼卡）的所有类别结果均达到或高于公布的正常均值。大多数患者无吞咽困难（89%）、反流（84%）和烧心（84%）。最常见的餐后症状是早饱（40%）。90%的患者体重指数在正常参考范围内。30例患者中位随访6年时的食管胃十二指肠镜检查显示残余食管无巴雷特化生。7例患者因结肠冗长再次手术。
结肠代食管术后长期饮食满意度和生活质量良好。大多数患者无吞咽困难，很少需要因冗长而进行修正。这些结果应鼓励在食管切除术后预期长期存活的患者中使用结肠代食管。
