Boshier P R, Adam M E, Doran S, Muthuswamy K, Hanna G B
Department of Surgery and Cancer, Imperial College London, UK.
Dis Esophagus. 2018 Oct 1;31(10). doi: 10.1093/dote/doy038.
Various methods have been described to aid pyloric drainage in patients undergoing esophagectomy with gastric reconstruction. These techniques are intended to prevent delayed gastric empting following esophagectomy that can be associated with early morbidity and long-term functional complaints. The current study aims to review the safety and efficacy of a pyloric stretch procedure performed at the time of esophagectomy. To achieve this, a retrospective review of 100 consecutive patients undergoing esophagectomy during the period 2011-2016 was performed. Until May 2013, no patients received intraoperative pyloric intervention. After May 2013, all patients (N = 50) underwent intraoperative pyloric stretch procedure that involved bidirectional mechanical dilatation of the pylorus. Postoperative outcomes including result of routine oral contrast swallow and early morbidity were evaluated. Intraoperative pyloric stretching was performed safely and without local complications in all patients. Delayed gastric emptying was observed significantly less frequently in patients who received intraoperative pyloric stretching (48% vs. 22%, P = 0.006). No significant differences were observed in postoperative outcomes. When considering all patients as a single cohort, the presence of delayed gastric emptying was associated with significantly higher rates of postoperative pneumonia (71% vs. 45%, P = 0.010), cardiac complications (57% vs. 25%, P = 0.001) as well as longer hospital say (12 vs. 15 days, P < 0.001) and delay to free oral fluid intake (7 vs. 9 days, < 0.001). Binary logistic regression identified age and postoperative delayed gastric emptying as independent risk factors for postoperative pneumonia. In conclusion, this study has demonstrated the safety and efficacy an intraoperative pyloric stretch procedure for the prevention of delayed gastric emptying following esophagectomy.
已有多种方法用于辅助接受食管切除术并进行胃重建的患者的幽门引流。这些技术旨在预防食管切除术后胃排空延迟，而这可能与早期发病及长期功能问题相关。本研究旨在回顾食管切除术中进行幽门扩张术的安全性和有效性。为此，对2011年至2016年期间连续接受食管切除术的100例患者进行了回顾性研究。在2013年5月之前，没有患者接受术中幽门干预。2013年5月之后，所有患者（N = 50）均接受了术中幽门扩张术，该手术包括对幽门进行双向机械扩张。评估了术后结果，包括常规口服造影剂吞咽结果和早期发病率。所有患者术中幽门扩张均安全进行，且无局部并发症。接受术中幽门扩张的患者胃排空延迟的发生率显著降低（48%对22%，P = 0.006）。术后结果未见显著差异。将所有患者视为一个队列时，胃排空延迟与术后肺炎发生率显著升高（71%对45%，P = 0.010）、心脏并发症（57%对25%，P = 0.001）以及住院时间延长（12天对15天，P < 0.001）和开始自由口服液体摄入延迟（7天对9天，P < 0.001）相关。二元逻辑回归确定年龄和术后胃排空延迟是术后肺炎的独立危险因素。总之，本研究证明了术中幽门扩张术预防食管切除术后胃排空延迟的安全性和有效性。
