Csendes A, Braghetto I, Burdiles P, Díaz J C, Maluenda F, Korn O
Department of Surgery, University Hospital, Santiago, Chile.
Ann Surg. 1997 Aug;226(2):123-33. doi: 10.1097/00000658-199708000-00002.
To determine the results of a new surgical procedure for patients with Barrett's esophagus.
In addition to pathologic acid reflux into the esophagus in patients with severe gastroesophageal reflux and Barrett's esophagus, increased duodenoesophegeal reflux has been implicated. The purpose of this study was to establish the effect of a new bile diversion procedure in these patients.
Sixty-five patients with Barrett's esophagus were included in this study. A complete clinical, radiologic, endoscopic, and bioptic evaluation was performed before and after surgery. Besides esophageal manometry, 24-hour pH studies and a Bilitec test were performed. After surgery, gastric emptying of solids, gastric acid secretion, and serum gastrin were determined. All patients underwent highly selective vagotomy, antireflux procedure (posterior gastropexy with cardial calibration or fundoplication), and duodenal switch procedure, with a Roux-en-Y anastomosis 60 cm in length.
No deaths occurred. Morbidity occurred in 14% of the patients. A significant improvement in symptoms, endoscopic findings, and radiologic evaluation was achieved. Lower esophageal sphincter pressure increased significantly (p < 0.0001), as did abdominal length and total length of the sphincter (p < 0.0001). The presence of an incompetent sphincter decreased from 87.3% to 20.9% (p < 0.0001). Three of seven patients with dysplasia showed disappearance of this dysplasia. Serum gastrin and gastric emptying of solids after surgery remained normal. Basal and peak acid output values were low. Twenty-four hour pH studies showed a mean value of 24.8% before surgery, which decreased to 4.8% after surgery (p < 0.0001). The determination of the percentage time with bilirubin in the esophagus was 23% before surgery; this decreased to 0.7% after surgery (p < 0.0001). Late results showed Visick I and II gradation in 90% of the patients and grade III and IV in 10% of the patients.
This physiologic approach to the surgical treatment of patients with Barrett's esophagus produces a permanent decrease of acid secretion (and avoids anastomotic ulcer), decreases significantly acid reflux into the esophagus, and abolishes duodenoesophageal reflux permanently. Significant clinical improvement occurs, and dysplastic changes at Barrett's epithelium disappear in almost 50% of the patients.
确定一种针对巴雷特食管患者的新手术方法的效果。
除了严重胃食管反流和巴雷特食管患者存在病理性胃酸反流至食管外，十二指肠食管反流增加也与之相关。本研究的目的是确定一种新的胆汁转流手术对这些患者的影响。
本研究纳入了65例巴雷特食管患者。在手术前后进行了全面的临床、放射学、内镜和活检评估。除了食管测压外，还进行了24小时pH监测和Bilitec检测。术后测定了固体食物胃排空、胃酸分泌和血清胃泌素。所有患者均接受了高选择性迷走神经切断术、抗反流手术（贲门校准后位胃固定术或胃底折叠术）以及十二指肠转流手术，采用长度为60 cm的Roux-en-Y吻合术。
无死亡病例。14%的患者出现了并发症。症状、内镜检查结果和放射学评估均有显著改善。食管下括约肌压力显著升高（p < 0.0001），括约肌的腹段长度和总长度也显著增加（p < 0.0001）。括约肌功能不全的发生率从87.3%降至20.9%（p < 0.0001）。7例发育异常患者中有3例发育异常消失。术后血清胃泌素和固体食物胃排空仍保持正常。基础胃酸分泌量和高峰胃酸分泌量较低。24小时pH监测显示术前平均值为24.8%，术后降至4.8%（p < 0.0001）。术前食管中胆红素存在时间的百分比测定为23%，术后降至0.7%（p < 0.0001）。远期结果显示，90%的患者为Visick I级和II级，10%的患者为III级和IV级。
这种针对巴雷特食管患者的生理性手术治疗方法可使胃酸分泌永久性减少（并避免吻合口溃疡），显著减少胃酸反流至食管，并永久性消除十二指肠食管反流。临床症状有显著改善，近50%的患者巴雷特上皮的发育异常改变消失。
