目的:總結(jié)食管胸段癌Ivor Lewis食管切除術(shù)后胃延遲排空的防治對策。方法:回顧性分析我院3100例食管胸中下段癌行Ivor Lewis食管切除術(shù)后胃延遲排空的發(fā)生率。根據(jù)術(shù)中采取不同措施分為:A組(裂孔切開)和B組(不作裂孔切開),P組(幽門括約肌捏斷)和N組(不作幽門處理),管胃組(管胃替代食管)和全胃組(全胃代食管),PM組(幽門括約肌捏斷) 、PN組(不作幽門處理)和PP組(幽門成形)。比較不同處理方式前后胃延遲排空的發(fā)生率。結(jié)果:Ivor Lewis食管切除術(shù)后胃延遲排空的總的發(fā)生率為13.8%(427/3100)。術(shù)中裂孔擴大后胃延遲排空的發(fā)生率從32%(A組)降至21%(B組)(P lt;0.05);術(shù)中同時行幽門括約肌捏斷后胃延遲排空的發(fā)生率從21%(N組)降至9%(P組)(P lt;0.05);采用管胃替代食管后胃延遲排空的發(fā)生率從19.5%(全胃組)降至8.3%(管胃組)(P lt;0.05);管胃組中PN組胃延遲排空的發(fā)生率為15%,PP組為8%,行幽門成形(PP組)后降至2% (P lt;0.05)。結(jié)論:胃延遲排空是Ivor Lewis食管切除術(shù)后主要的并發(fā)癥,術(shù)中擴大食管裂孔、管胃替代食管和幽門成形可有效防治術(shù)后胃延遲排空的發(fā)生。
引用本文： 方強,任光國,韓泳濤,陳利華. IVOR LEWIS食管切除術(shù)后胃延遲排空的防治對策. 華西醫(yī)學, 2009, 24(10): 2532-2535. doi: 復制
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- 1. MATHISEN D J. Right Thoracoabdominal Approaches/Ivor LewisMcKeown Procedures[M]. Esophageal Surgery, Second Edition, 2002, Health Science Asia, Elsevier Science: 818-824.
- 2. YOICHI TABIRA, TOMONORI SAKAGUCHI, HIROSHI KUHARA, et al. The width of a gastric tube has no impact on outcome after esophagectomy[J]. Am J Surg, 2004,187:417-421.
- 3. 高宗人,赫捷主編.食管癌[M].北京:北京大學醫(yī)學出版社,2008:187-188.
- 4. 陳克能, 師曉天, 馮瑞慶. 食管癌賁門癌的手術(shù)入路比較[J]. 中華胸心血管外科雜志,1998, 14: 232-233.
- 5. KIM J H, LEE H S, KIM M S, et al. Balloon dilatation of the pylorus for delayed gastric emptying after esophagectomy[J]. Eur J Cardiothorac Surg,2008,33(6):1105-1111.
- 6. PANEBIANCO V, FRANCIONI F, ANZIDEI M, et al. Magnetic resonancefluoroscopy as longterm followup examination in patients with narrow gastric tube reconstruction after radical esophagectomy[J]. Eur J Cardiothorac Surg, 2006,30(4):663-668.
- 7. PALMES D, WEILINGHOFF M, COLOMBOBENKMANN M, et al. Effect of pyloric drainage procedures on gastric passage and bile reflux after esophagectomy with gastric conduit reconstruction[J]. Langenbecks Arch Surg, 2007,392(2):135-1341.
- 8. URSCHEL J D, BLEWETT C J, YOUNG J E, et al. Pyloric drainage (pyloroplasty) or no drainage in gastric reconstruction after esophagectomy: a metaanalysis of randomized controlled trials[J]. Dig Surg, 2002,19(3):160-164.