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目的:总结食管胸段癌Ivor Lewis食管切除术后胃延迟排空的防治对策。方法:回顾性分析我院3100例食管胸中下段癌行Ivor Lewis食管切除术后胃延迟排空的发生率。根据术中采取不同措施分为:A组(裂孔切开)和B组(不作裂孔切开),P组(幽门括约肌捏断)和N组(不作幽门处理),管胃组(管胃替代食管)和全胃组(全胃代食管),PM组(幽门括约肌捏断)、PN组(不作幽门处理)和PP组(幽门成形)。比较不同处理方式前后胃延迟排空的发生率。结果:IvorLewis食管切除术后胃延迟排空的总的发生率为13.8%(427/3100)。术中裂孔扩大后胃延迟排空的发生率从32%(A组)降至21%(B组)(P<0.05);术中同时行幽门括约肌捏断后胃延迟排空的发生率从21%(N组)降至9%(P组)(P<0.05);采用管胃替代食管后胃延迟排空的发生率从19.5%(全胃组)降至8.3%(管胃组)(P<0.05);管胃组中PN组胃延迟排空的发生率为15%,PP组为8%,行幽门成形(PP组)后降至2%(P<0.05)。结论:胃延迟排空是Ivor Lewis食管切除术后主要的并发症,术中扩大食管裂孔、管胃替代食管和幽门成形可有效防治术后胃延迟排空的发生。
Objective: To summarize the prevention and treatment of delayed gastric emptying after esophageal thoracic esophagectomy with esophageal thoracic carcinoma. Methods: A retrospective analysis of 3100 cases of lower esophageal cancer in our hospital after Ivor Lewis esophagectomy delayed gastric emptying incidence. According to intraoperative different measures are divided into: A group (open hole) and B group (no hole open), P group (pyloric sphincter muscle pinch) and N group (not for pylorus treatment), tube and stomach group Esophagus) and the whole stomach group (all the stomach on behalf of the esophagus), PM group (pyloric sphincter pinch), PN group (no pyloric treatment) and PP group (pyloric forming). The incidence of delayed gastric emptying before and after different treatments were compared. RESULTS: The overall incidence of delayed gastric emptying after Ivor Lewis esophagectomy was 13.8% (427/3100). The incidence of delayed gastric emptying during the operation was reduced from 32% (group A) to 21% (group B) (P <0.05). The incidence of postoperative delayed gastric emptying during pyloric sphincter inoculation was reduced from 21 (P <0.05). The incidence of delayed gastric emptying after tube-tube replacement of the esophagus dropped from 19.5% (whole stomach group) to 8.3% (tube-stomach group) (P <0.05) P <0.05). The incidence of delayed gastric emptying in PN group was 15% in tube group and 8% in PP group, and decreased to 2% in PP group (P <0.05). Conclusion: Delayed gastric emptying is the main complication after Ivor Lewis esophagectomy. Expanding the esophageal foramen, replacing the esophagus and the pylorus can effectively prevent postoperative delayed gastric emptying.