Fritz Stefan, Feilhauer Katharina, Schaudt André, Killguss Hansjörg, Esianu Eduard, Hennig René, Köninger Jörg
Department of General, Visceral, Thoracic and Transplantation Surgery, Katharinenhospital Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany.
BMC Surg. 2018 Mar 1;18(1):13. doi: 10.1186/s12893-018-0347-x.
Pylorotomy and pyloroplasty in thoracoabdominal esophagectomy are routinely performed in many high-volume centers to prevent delayed gastric emptying (DGE) due to truncal vagotomy. Currently, controversy remains regarding the need for these practices. The present study aimed to determine the value and role of pyloric drainage procedures in esophagectomy with gastric replacement.
A retrospective review of prospectively collected data was performed for all consecutive patients who underwent thoracoabdominal resection of the esophagus between January 2009 and December 2016 at the Katharinenhospital in Stuttgart, Germany. Clinicopathologic features and surgical outcomes were evaluated with a focus on postoperative nutrition and gastric emptying.
The study group included 170 patients who underwent thoracoabdominal esophageal resection with a gastric conduit using the Ivor Lewis approach. The median age of the patients was 64 years. Most patients were male (81%), and most suffered from adenocarcinoma of the esophagus (75%). The median hospital stay was 20 days, and the 30-day hospital death rate was 2.9%. According to the department standard, pylorotomy, pyloroplasty, or other pyloric drainage procedures were not performed in any of the patients. Overall, 28/170 patients showed clinical signs of DGE (16.5%).
In the literature, the rate of DGE after thoracoabdominal esophagectomy is reported to be approximately 15%, even with the use of pyloric drainage procedures. This rate is comparable to that reported in the present series in which no pyloric drainage procedures were performed. Therefore, we believe that pyloric drainage procedures may be unwarranted in thoracoabdominal esophagectomy. However, future randomized trials are needed to ultimately confirm this supposition.
在许多大型医疗中心，胸腹段食管癌切除术中常规进行幽门切开术和幽门成形术，以预防因迷走神经干切断术导致的胃排空延迟（DGE）。目前，对于这些操作的必要性仍存在争议。本研究旨在确定幽门引流术在胃代食管食管癌切除术中的价值和作用。
对2009年1月至2016年12月期间在德国斯图加特凯瑟琳医院连续接受胸腹段食管切除术的所有患者进行前瞻性收集数据的回顾性分析。评估临床病理特征和手术结果，重点关注术后营养和胃排空情况。
研究组包括170例行胸腹段食管切除术并采用Ivor Lewis术式用胃管重建的患者。患者的中位年龄为64岁。大多数患者为男性（81%），且大多数患有食管腺癌（75%）。中位住院时间为20天，30天内的医院死亡率为2.9%。根据科室标准，所有患者均未进行幽门切开术、幽门成形术或其他幽门引流术。总体而言，170例患者中有28例出现DGE的临床症状（16.5%）。
在文献中，胸腹段食管癌切除术后DGE的发生率据报道约为15%，即使采用了幽门引流术。这一发生率与本系列报道的未进行幽门引流术的发生率相当。因此，我们认为胸腹段食管癌切除术中幽门引流术可能没有必要。然而，需要未来的随机试验来最终证实这一推测。
