食管癌根治术中附加幽门成形预防移植胸胃排空障碍1610例临床分析

Clinical analysis of the function of pyloroplasty performed during radical resection of esophageal carcinoma to prevent delayed emptying of intrathoracic stomach in 1610 cases

目的 评价食管癌根治胃代食管术中附加幽门成形预防术后移植胸胃排空障碍的作用。方法 1988-2003年在1610例食管癌切除胃代食管术中,附加以幽门环为中心、幽门纵切横缝成形术,成形后幽门孔径增至1.5 cm。结果 1610例除发生心肺并发症等死亡7例外,其余病例术后未发生移植胸胃排空障碍。结论 在食管癌根治胃代食管术中附加幽门成形可以使十二指肠成为胃腔的延续,使移植胸胃与十二指肠压力基本相等,减少了胸腔负压对移植胸胃的影响,有利于胸胃的排空;幽门成形术是消除因迷走神经切断破坏而致幽门痉挛、胸胃张力减低、胃液大量潴留、胸胃排空障碍等不利因素的较好手术方法。

Objective To evaluate the function of pyloroplasty performed during radical resection of esophageal carcinoma and esophagogastrostomy to prevent delayed emptying of intrathoracic stomach.Method Between 1988 and 2003, during resection of esophageal carcinoma and esophagogastrostomy in 1610 patients with esophageal carcinoma, pyloroplasty was performed, in which the pylorus was cut longitudinally and sutured horizontally. Thus, the diameter of the opening of pylorus increased to 1.5 cm.Results In the 1610 patients, except seven who died of the heart and lung complications, none of the others suffered from the dekyed emptying of intrathoracic stomach. Conclusion After pyloroplasty performed during radical resection of esophageal carcinoma and esophagogastrostomy, the duodenum served as a part of gastric cavity.The pressure in duodenum equaled the pressure in intrathoracic stomach, thus the pyloroplasty reduced the effect of the negative pressure of the thoracic cavity on the intrathoracic stomach, which was favorable to the emptying of intrathoracic stomach. Pyloroplasty is a desirable surgical operation to eliminate the unfavorable factors caused by vagotomy, such as the pylorus spasm, decreased tension of intrathoracic stomach, retention of a large amount of gastric juice and delayed emptying of intrathoracic stomach.