Hwang T L, Chen M F
Department of Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, ROC.
Int Surg. 1996 Apr-Jun;81(2):119-21.
For the comparison of advantage and outcome, thirty six patients with corrosive upper GI injury resulting in only distal gastric outlet obstruction and failing to receive endoscopic balloon dilatation underwent prospective randomized different surgical treatments in the past years. Sixteen patients (Group A) received early definitive treatment with antrectomy or pyloroplasty for their gastric outlet obstruction, only 3 (18.8%) of them needed a second operation for the delayed esophageal stricture. The long-term follow-up for these patients revealed the stricture resolved after the antrectomy or pyloroplasty. All of the other 20 patients (Group B) who received gastrostomy plus feeding jejunostomy during their first operation required a second operation. Among the 20 patients receiving a second operation, delayed esophageal stricture was the reason in only 4 patients. It meant that 16 patients (80%) of Group B were able to avoid the second operation if early definitive treatment for their gastric outlet obstruction was performed during the first operation. We concluded that the early definitive treatment of gastric outlet obstruction can give patients a better quality of life, avoid a second operation in about 80% of them and save operative time in those who need a second operation for final esophageal reconstruction.
为了比较优势和结果，在过去几年中，36例因腐蚀性上消化道损伤仅导致胃远端出口梗阻且未接受内镜球囊扩张治疗的患者接受了前瞻性随机不同手术治疗。16例患者（A组）因胃出口梗阻接受了早期确定性治疗，即胃窦切除术或幽门成形术，其中只有3例（18.8%）因延迟性食管狭窄需要二次手术。对这些患者的长期随访显示，胃窦切除术或幽门成形术后狭窄得到缓解。其他20例患者（B组）在首次手术时接受了胃造口术加空肠造口术，均需要二次手术。在接受二次手术的20例患者中，只有4例是因延迟性食管狭窄。这意味着，如果在首次手术时对胃出口梗阻进行早期确定性治疗，B组中16例患者（80%）能够避免二次手术。我们得出结论，胃出口梗阻的早期确定性治疗可以为患者提供更好的生活质量，约80%的患者可避免二次手术，并为那些需要二次手术进行最终食管重建的患者节省手术时间。
