ازوفاژکتومی بدون پیلوروپلاستی یا پیلورومیوتومی

نیک بخش, نوین; هاشمی, رضا; نورباران, عسکری

ازوفاژکتومی بدون پیلوروپلاستی یا پیلورومیوتومی

نوع مقاله : مقاله های پژوهشی

نویسندگان

¹ دانشیار، گروه جراحی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی بابل، بابل، ایران

² استادیار، گروه جراحی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی بابل، بابل، ایران

چکیده

مقدمه:سرطان مری از بیماری‌های مهلک در دنیا محسوب می‌شود و در ایران به ویژه در شمال کشور، از شیوع بالایی برخوردار است. درمان اصلی این بیماری جراحی است. به دلیل انجام ناگزیر واگوتومی حین ازوفاژکتومی ،انجام یا عدم انجام پیلوروپلاستی یا پیلورومیوتومی به عنوان روشی جهت درناژ پیلور و جلوگیری از تأخیر در تخلیه‌ی معده، در بین جراحان مورد بحث و اختلاف نظر است. هدف از این مطالعه، بررسی عوارض ازوفاژکتومی بدون پیلوروپلاستی یا پیلورومیوتومی بود.روش‌ها:در این مطالعه‌ی آینده‌نگر، میزان عوارض پس از عمل جراحی ازوفاژکتومی بدون پیلورومیوتومی یا پیلوروپلاستی در 50 بیمار مبتلا به سرطان مری بررسی شد.یافته‌ها:از مجموع 50 بیمار 48 درصد زن و 52 درصد مرد و از این بین، 92 درصد مبتلا به SCC (Squamous cell carcinoma) و 8 درصد مبتلا به آدنوکارسینوم بودند. عوارض زودرس پس از عمل جراحی شامل ترشح از محل آناستوموز (2 درصد)، افیوژن پلورال (10 درصد)، پنوموتوراکس (4 درصد)، پنومونی (14 درصد)، آریتمی قلبی (20 درصد)، دلیریوم (4 درصد)، آسیب عصب راجعه (8 درصد) و عوارض دیررس پس از جراحی شامل تأخیر در تخلیه‌ی معده (34 درصد)، GOO (Gastric outlet obstruction) (2 درصد)، سندرم دامپینگ (6 درصد) و تنگی محل آناستوموز (18 درصد) بود.نتیجه‌گیری:با توجه به این که ازوفاژکتومی بدون پیلوروپلاستی عوارض ناشی از ازوفاژکتومی را افزایش نمی‌دهد و با توجه به کوتاه شدن زمان عمل، می‌توان ازوفاژکتومی را بدون پیلوروپلاستی یا پیلورومیوتومی انجام داد.

کلیدواژه‌ها

عنوان مقاله [English]

Esophagectomy without Pyloroplasty or Pyloromyotomy

نویسندگان [English]

Novin Nikbakhsh ¹
Reza Hashemi ²
Askari Noorbaran ²

¹ Associate Professor, Department of Surgery, School of Medicine, Babol University of Medical Sciences, Babol, Iran

² Assistant Professor, Department of Surgery, School of Medicine, Babol University of Medical Sciences, Babol, Iran

چکیده [English]

Background: Esophageal cancer is one of the deadliest diseases in the world and in particular, has high prevalence in the north of the Iran. The main treatment for this condition is surgery. Because of necessity of vagotomy during esophagectomy, doing or not doing pyloroplasty or pyloromyotomy as a way to prevent delay in emptying the stomach (pyloric drainage), is controversial among surgeons. The aim of this study was to investigate the effects of esophagectomy without pyloroplasty or pyloromyotomy.Methods: In this prospective study, complications of esophagectomy without pyloromyotomy or pyloroplasty in 50 patients with esophageal cancer were reviewed.Findings: 50 patients, 24 women and 26 men, were enrolled, 92% with squamous cell carcinoma (SCC) and 8% with adenocarcinoma. Postoperative early complications included anastomosis leakage (2%), pleural effusion (10%), pneumothorax (4%), pneumonia (14%), cardiac arrhythmias (20%), delirium (4%), and recurrent nerve injury (8%). Late complications after surgery including delayed gastric emptying (34%), gastric outlet obstruction (GOO) (2%), dumping syndrome (6%), and anastomsis stenosis (18%).Conclusion: Based on our findings, esophagectomy without pyloroplasty not only did not increase the complications, but also could shorten the operation time. Therefore, esophagectomy can be performed without pyloroplasty or pyloromyotomy.

کلیدواژه‌ها [English]

Esophageal cancer
Esophagectomy
Pyloroplasty
Pyloromyotomy

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