The Journal of thoracic and cardiovascular surgery · 2010
Refractory cervical esophagogastric anastomotic strictures: management and outcomes.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Davis Samantha J, Zhao Lili, Chang Andrew C, Orringer Mark B
Аннотация
OBJECTIVE: For recalcitrant cervical esophagogastric anastomotic strictures after transhiatal esophagectomy, a protocol of self-dilatation was developed at the University of Michigan Medical Center, as previously described. This study was undertaken to determine the outcomes of this treatment.
METHODS: Self-dilatation was required in 158 (7.6%) of 2075 patients with cervical esophagogastric anastomotic strictures after transhiatal esophagectomy. An esophageal-specific survey evaluated the frequency and duration of dilatation, swallowing function, and satisfaction with treatment. The relationship among anastomotic leak, subsequent stricture, and the need for self-dilatation was assessed. A validated survey tool, the Short Form 36-item, version 2, was used to assess quality of life.
RESULTS: At the time of this study, 78 of 158 patients were alive; 34 (43%) participated in the esophageal-specific survey. Median duration of self-dilatation was 10 years. The majority were satisfied with their ability to eat. No adverse events were reported. All patients said they would use self-dilatation therapy again under similar circumstances. Of these patients, 20 (59%) responded to the Short Form 36-item, version 2. Compared with the general population, 55% and 70% of participants scored at or above the norm for physical health and mental health status, respectively. Patients who required self-dilatation were twice as likely to have a history of cervical esophagogastric anastomotic leak as those who did not require this therapy (P=.0002).
CONCLUSIONS: Refractory cervical esophagogastric anastomotic strictures are best managed initially with frequent outpatient dilatations, then transitioning to self-dilatation. Home use of Maloney dilators is a safe, well-tolerated, convenient, and cost-effective way to maintain comfortable swallowing. The effectiveness of self-dilatation therapy is reflected in this cohort's good quality of life and level of functioning.
METHODS: Self-dilatation was required in 158 (7.6%) of 2075 patients with cervical esophagogastric anastomotic strictures after transhiatal esophagectomy. An esophageal-specific survey evaluated the frequency and duration of dilatation, swallowing function, and satisfaction with treatment. The relationship among anastomotic leak, subsequent stricture, and the need for self-dilatation was assessed. A validated survey tool, the Short Form 36-item, version 2, was used to assess quality of life.
RESULTS: At the time of this study, 78 of 158 patients were alive; 34 (43%) participated in the esophageal-specific survey. Median duration of self-dilatation was 10 years. The majority were satisfied with their ability to eat. No adverse events were reported. All patients said they would use self-dilatation therapy again under similar circumstances. Of these patients, 20 (59%) responded to the Short Form 36-item, version 2. Compared with the general population, 55% and 70% of participants scored at or above the norm for physical health and mental health status, respectively. Patients who required self-dilatation were twice as likely to have a history of cervical esophagogastric anastomotic leak as those who did not require this therapy (P=.0002).
CONCLUSIONS: Refractory cervical esophagogastric anastomotic strictures are best managed initially with frequent outpatient dilatations, then transitioning to self-dilatation. Home use of Maloney dilators is a safe, well-tolerated, convenient, and cost-effective way to maintain comfortable swallowing. The effectiveness of self-dilatation therapy is reflected in this cohort's good quality of life and level of functioning.
Предметные рубрики MeSH
AgedAnastomosis, SurgicalChi-Square DistributionDeglutitionDeglutition DisordersDilatationEsophageal StenosisEsophagectomyEsophagogastric JunctionFemaleHumansKaplan-Meier EstimateMaleMichiganMiddle AgedPatient SatisfactionQuality of LifeRecovery of FunctionSelf CareStomach DiseasesSurveys and QuestionnairesTime FactorsTreatment Outcome