Kim Dohun
Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
Korean J Thorac Cardiovasc Surg. 2020 Aug 5;53(4):233-241. doi: 10.5090/kjtcs.2020.53.4.233.
Vagal damage and subsequent pyloric denervation inevitably occur during esophagectomy, potentially leading to delayed gastric emptying (DGE). The choice of an optimal pyloric procedure to overcome DGE is important, as such procedures can lead to prolonged surgery, shortening of the conduit, disruption of the blood supply, and gastric dumping/bile reflux. This study investigated various pyloric methods and analyzed comparative studies in order to determine the optimal pyloric procedure. Surgical procedures for the pylorus include pyloromyotomy, pyloroplasty, or digital fracture. Botulinum toxin injection, endoscopic balloon dilatation, and erythromycin are non-surgical procedures. The scope, technique, and effects of these procedures are changing due to advances in minimally invasive surgery and postoperative interventions. Some comparative studies have shown that pyloric procedures are helpful for DGE, while others have argued that it is difficult to reach an objective conclusion because of the variety of definitions of DGE and evaluation methods. In conclusion, recent advances in interventional technology and minimally invasive surgery have led to questions regarding the practice of pyloric procedures. However, many clinicians still perform them and they are at least somewhat effective. To provide guidance on the optimal pyloric procedure, DGE should first be defined clearly, and a large-scale study with an objective evaluation method will then be required.
在食管切除术过程中，不可避免地会发生迷走神经损伤及随后的幽门去神经支配，这可能导致胃排空延迟（DGE）。选择最佳的幽门手术方法来克服DGE至关重要，因为此类手术可能会导致手术时间延长、管道缩短、血供中断以及胃倾倒/胆汁反流。本研究调查了各种幽门手术方法，并分析了比较研究，以确定最佳的幽门手术方式。针对幽门的手术方法包括幽门肌切开术、幽门成形术或手法断裂。肉毒杆菌毒素注射、内镜球囊扩张和红霉素属于非手术方法。由于微创手术和术后干预的进展，这些手术方法的范围、技术和效果正在发生变化。一些比较研究表明，幽门手术对DGE有帮助，而另一些研究则认为，由于DGE的定义和评估方法多种多样，很难得出客观结论。总之，介入技术和微创手术的最新进展引发了关于幽门手术实践的问题。然而，许多临床医生仍在实施这些手术，而且它们至少有一定效果。为了为最佳幽门手术提供指导，首先应明确界定DGE，然后需要开展一项采用客观评估方法的大规模研究。
