Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
Surg Endosc. 2020 Apr;34(4):1847-1855. doi: 10.1007/s00464-019-06951-3. Epub 2019 Jul 11.
Gastroparesis is a debilitating functional disorder of the stomach marked by delayed gastric emptying in the absence of mechanical obstruction. Patients with severe, refractory symptoms may ultimately be managed with Roux-en-Y reconstruction; however, it is unclear whether the stomach should be left in situ, similar to a conventional gastric bypass, or resected as in gastrectomy.
All patients undergoing Roux-en-Y for the treatment of gastroparesis (GP) at our institution from September 2010 through March 2018 were retrospectively reviewed. Patients with prior gastric resection or whose primary operative indication was not gastroparesis were excluded from analysis.
Twenty-six patients underwent Roux-en-Y with stomach left in situ (RY-SIS) and twenty-seven patients underwent gastrectomy with Roux-en-Y reconstruction during the study period. The mean age was 49.7 years in the RY-SIS cohort and 48.5 years in the gastrectomy cohort. Etiology of GP was similar between the two cohorts. Patients undergoing gastrectomy were more likely to have previous interventions for GP (63.0% vs. 26.9%). RY-SIS was associated with a shorter operative time (155 vs. 223 min), less blood loss (24 vs. 130 mL), and shorter length of stay (4.0 vs. 7.2 days). Twelve patients (44.4%) had complications within 30 days following gastrectomy compared to two patients (7.7%) following RY-SIS (p = 0.001). Patients in the RY-SIS cohort were more likely to require further subsequent surgical intervention for GP (23.1% vs. 3.7%, p = 0.04). At last follow-up, there were no differences in reported GP symptoms or symptom scoring.
Gastrectomy was associated with greater perioperative morbidity compared to leaving the stomach in situ. Symptomatic improvement at intermediate follow-up was equivalent following either procedure. However, patients undergoing RY-SIS were more likely to require subsequent surgical intervention, suggesting that gastrectomy may be a more definitive operation for the management of medically refractory gastroparesis.
胃轻瘫是一种以胃排空延迟为特征的、使人虚弱的胃部功能障碍，而这种胃排空延迟在没有机械梗阻的情况下发生。严重、难治性症状的患者最终可能需要接受 Roux-en-Y 重建；然而，目前尚不清楚胃是否应该保留在原位，类似于常规的胃旁路手术，还是像胃切除术那样切除。
对我院 2010 年 9 月至 2018 年 3 月期间接受 Roux-en-Y 治疗胃轻瘫（GP）的所有患者进行回顾性分析。排除了既往胃切除术或主要手术指征不是胃轻瘫的患者。
研究期间，26 例患者接受了保留胃的 Roux-en-Y 手术（RY-SIS），27 例患者接受了胃切除术和 Roux-en-Y 重建。RY-SIS 组的平均年龄为 49.7 岁，胃切除术组为 48.5 岁。两组 GP 的病因相似。接受胃切除术的患者更有可能以前接受过 GP 治疗（63.0% vs. 26.9%）。RY-SIS 与更短的手术时间（155 分钟 vs. 223 分钟）、更少的出血量（24 毫升 vs. 130 毫升）和更短的住院时间（4.0 天 vs. 7.2 天）相关。胃切除术组有 12 例（44.4%）患者在术后 30 天内出现并发症，而 RY-SIS 组只有 2 例（7.7%）患者出现并发症（p=0.001）。RY-SIS 组的患者更有可能需要进一步的后续手术干预治疗 GP（23.1% vs. 3.7%，p=0.04）。在最后一次随访时，两种手术方式的患者报告的 GP 症状或症状评分均无差异。
与保留胃原位相比，胃切除术与更大的围手术期发病率相关。两种手术方式在中期随访时的症状改善程度相当。然而，接受 RY-SIS 的患者更有可能需要进一步的手术干预，这表明胃切除术可能是治疗药物难治性胃轻瘫的更有效方法。
