Brody Fred, Zettervall Sara L, Richards Nathan G, Garey Cathy, Amdur Richard L, Saddler Antoinette, Ali M Aamir
Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC.
Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC.
J Am Coll Surg. 2015 Jan;220(1):57-63. doi: 10.1016/j.jamcollsurg.2014.10.001. Epub 2014 Oct 13.
Gastric electrical stimulation (GES) is used to treat medically refractory gastroparesis. However, there are few large series with outcomes beyond 12 months. This study reports surgical outcomes of GES for patients up to 8 years receiving treatment from a single institution.
A prospective database was reviewed from 2003 to 2013 for patients undergoing GES. Baseline patient characteristics were recorded, including age, sex, cause of gastroparesis, gastric emptying, and Hgb A1C. Outcomes variables included nutrition supplementation, additional operations, 30-day morbidity, and mortality. Pre- and postoperative pain and function scores are analyzed over time using generalized estimating equations. Patient outcomes in terms of reoperation rates and types of operations are also reviewed.
Seventy-nine patients underwent GES with a mean ± SD age of 43 ± 11 years and a BMI of 27 ± 8 kg/m(2). Symptom scores were available for 60 patients: 60 patients at baseline, 52 patients at 1 year, 14 patients during years 2 to 3, and 18 patients during years 4 to 8. Symptom scores decreased considerably in all categories. At 1-year follow-up, 44% and 31% of patients had at least a 25% reduction in symptom distress for functional and pain symptoms, respectively. Preoperatively, 9 patients required nutrition supplementation. After implantation, 34 (43%) patients underwent additional operations, with a mean of 2.15 operations per patient. Generator-related causes were the most common indication for reoperation, including battery exchanges and relocation. Other operations included 8 gastrectomies and 7 median arcuate ligament releases. Postoperatively, 4 patients required supplemental nutrition. There were no 30-day mortalities, but 11 patients died during the study period.
Gastric electrical stimulation was significantly associated with reductions in both functional and pain-related symptoms of gastroparesis. Patients who undergo GES have a high likelihood of additional surgery.
胃电刺激（GES）用于治疗药物难治性胃轻瘫。然而，很少有超过12个月随访结果的大型系列研究。本研究报告了在单一机构接受治疗长达8年的患者接受GES的手术结果。
回顾了2003年至2013年接受GES治疗患者的前瞻性数据库。记录患者的基线特征，包括年龄、性别、胃轻瘫病因、胃排空和糖化血红蛋白（Hgb A1C）。结果变量包括营养补充、额外手术、30天发病率和死亡率。使用广义估计方程随时间分析术前和术后的疼痛及功能评分。还回顾了患者再次手术率和手术类型方面的结果。
79例患者接受了GES，平均年龄±标准差为43±11岁，体重指数（BMI）为27±8kg/m²。60例患者有症状评分：60例患者在基线时，52例患者在1年时，14例患者在第2至3年期间，18例患者在第4至8年期间。所有类别中的症状评分均显著降低。在1年随访时，分别有44%和31%的患者功能和疼痛症状的症状困扰至少减轻了25%。术前，9例患者需要营养补充。植入后，34例（43%）患者接受了额外手术，每位患者平均接受2.15次手术。与发生器相关的原因是再次手术最常见的指征，包括电池更换和重新定位。其他手术包括8例胃切除术和7例正中弓状韧带松解术。术后，4例患者需要补充营养。无30天死亡病例，但在研究期间有11例患者死亡。
胃电刺激与胃轻瘫的功能和疼痛相关症状的减轻显著相关。接受GES治疗的患者有较高的再次手术可能性。
