Tanaka Yujiro, Tainaka Takahisa, Uchida Hiroo
Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, 339-8551, Japan.
Surg Today. 2018 Nov;48(11):971-977. doi: 10.1007/s00595-018-1636-9. Epub 2018 Feb 12.
Total esophagogastric dissociation (TED) is used to treat gastroesophageal reflux (GER) after failed fundoplication in neurologically impaired patients. It is now performed for some otherwise healthy patients with severe GER. In this procedure, the gastrointestinal tract is reconstructed in a non-physiological way with a Roux-en-Y esophagojejunal anastomosis and jejuno-jejunostomy. Although TED eliminates almost all GER, some patients experience late complications. In this review, we investigated the long-term outcomes after TED to determine the best indications. In total, 147 neurologically impaired patients and 28 neurologically normal patients were identified. The total rate of complications requiring re-operation was 17.2% in neurologically impaired patients and 32.1% in normal patients, both higher than the rates associated with fundoplication. Although most authors added pyloroplasty when there was a concern of gastric emptying, this sometimes caused bile reflux. Nutritional and metabolic complications, including dumping syndrome and chronic digestive malabsorption, were also reported to occur after TED. TED is an option for the treatment of neurologically impaired patients with recurrent GER after fundoplication or who are at a high risk of recurrence of GER with fundoplication. However, neurologically normal patients who have the ability to obtain nutrition orally should consider options other than TED, as postoperative complications are frequent.
全食管胃离断术（TED）用于治疗神经功能受损患者胃底折叠术失败后的胃食管反流（GER）。现在，一些身体健康但患有严重GER的患者也会接受该手术。在此手术中，通过Roux-en-Y食管空肠吻合术和空肠空肠吻合术以非生理性方式重建胃肠道。虽然TED几乎消除了所有GER，但一些患者会出现晚期并发症。在本综述中，我们调查了TED后的长期结局以确定最佳适应症。总共确定了147例神经功能受损患者和28例神经功能正常患者。神经功能受损患者需要再次手术的并发症总发生率为17.2%，正常患者为32.1%，均高于胃底折叠术相关的发生率。尽管大多数作者在担心胃排空时会加做幽门成形术，但这有时会导致胆汁反流。营养和代谢并发症，包括倾倒综合征和慢性消化吸收不良，也被报道在TED后发生。TED是治疗胃底折叠术后复发性GER或胃底折叠术GER复发风险高的神经功能受损患者的一种选择。然而，有口服营养能力的神经功能正常患者应考虑TED以外的选择，因为术后并发症很常见。
