Zhang Lei, Hou Sheng-Cai, Miao Jin-Bai, Lee Hui
Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
J Surg Res. 2017 Jun 1;213:46-50. doi: 10.1016/j.jss.2017.02.012. Epub 2017 Feb 21.
The incidence of delayed gastric emptying (DGE) after esophagectomy is 10%-50%, which can interfere with postoperative recovery in the short-term and result in poor quality of life in the long term. Pyloric drainage is routinely performed to prevent DGE, but its role is highly controversial. The aim of this study was to report the rate of DGE after esophagectomy without pyloric drainage and to investigate its risk factors and the potential effect on recovery.
Between January 2010 and January 2015, we analyzed 285 consecutive patients who received an esophagectomy without pyloric drainage. Possible correlations between the incidence of DGE and its potential risk factors were examined in univariate and multivariate analyses, respectively. The outcomes of DGE were reviewed with a follow-up of 3 mo.
The overall rate of DGE after esophagectomy was 18.2% (52/285). Among perioperative factors, gastric size (gastric tube versus the whole stomach) was the only significant factor affecting the incidence of DGE in the univariate analysis. The patients who received a whole stomach as an esophageal substitute were more likely to develop DGE than were patients with a gastric tube (13.2% versus 22.4%; P = 0.05). No independent risk factor for DGE was found in the multivariate analysis. The incidence of major postoperative complications, including anastomotic leak, respiratory complications, and cardiac complications, was also not significantly different between both groups, with or without DGE. Within 3 mo of follow-up, most patients could effectively manage their DGE through medication (39/52) or endoscopic pyloric dilation (12/52), with only one patient requiring surgical intervention.
In our study, the overall incidence of DGE is about 20% for patients undergoing esophagectomy without pyloric drainage. Compared with prior findings, this does not result in a significantly increased incidence of DGE. In patients with symptoms of DGE after esophagectomy, prokinetic agents and endoscopic balloon dilation of the pylorus can be effective, as indicated by the high success rate and lack of significant complications.
食管癌切除术后胃排空延迟（DGE）的发生率为10% - 50%，这在短期内会干扰术后恢复，长期则会导致生活质量下降。常规进行幽门引流以预防DGE，但其作用极具争议。本研究的目的是报告食管癌切除术后未行幽门引流时DGE的发生率，并调查其危险因素以及对恢复的潜在影响。
在2010年1月至2015年1月期间，我们分析了285例连续接受食管癌切除术且未行幽门引流的患者。分别在单因素和多因素分析中检查DGE发生率与其潜在危险因素之间可能的相关性。对DGE的结果进行了为期3个月的随访复查。
食管癌切除术后DGE的总体发生率为18.2%（52/285）。在围手术期因素中，胃大小（胃管与全胃）是单因素分析中影响DGE发生率的唯一显著因素。以全胃作为食管替代物的患者比采用胃管的患者更易发生DGE（13.2%对22.4%；P = 0.05）。多因素分析未发现DGE的独立危险因素。无论有无DGE，两组术后主要并发症的发生率，包括吻合口漏、呼吸并发症和心脏并发症，也无显著差异。在随访的3个月内，大多数患者可通过药物治疗（39/52）或内镜下幽门扩张（12/52）有效处理DGE，仅1例患者需要手术干预。
在我们的研究中，未行幽门引流的食管癌切除患者中DGE的总体发生率约为20%。与先前的研究结果相比，这并未导致DGE发生率显著增加。如高成功率和无显著并发症所示，食管癌切除术后出现DGE症状的患者，促动力药物和内镜下幽门球囊扩张可能有效。
