Clinical Analysis Of Pyloric Obstruction After Esophagectomy(Report Of20Cases)

Objective:to investigate the factors causing the pyloric obstruction after esophagectomy in order to provide reference for decreasing the complication.Methods:A retrospective study was performed of20patients with postoperative pyloric obstruction from Jan2003to Jun2012, including14patients accepted the Ivor-lewis esophagectomy,2patients accepted left transthorcic approaches with anastomosis above the atora arch and3patients accepted left transthorcic approaches with anastomosis in the neck.Result:In the20patiens,18patients took place from Jan2003to Jan2006, in which17patient recovered after consevative treatment,1patients recovered after sugery treatment and1patient died. After the analysis of these patients, we summersized the reasons may causing pyloric obstruction are:1. the gastric herina into the chest and caused gastirc volvulus by the gravity of the gatric content, which is the most common circumstance2. the location of the anastomotic stoma was too high and cause a great tension toward the polyrus, which force the polyrus forming a horn malformation and4was confirmed by sugery3. othe reasons:the insufficitent free of the pyloric adhension caused compression toward the polyrus, rebulided-hiatus esophagus of diaphragm was small, the weaken gastric peristalsis because of the destruciton of the nervi vagus, stimulation during the surgery and Gastric ischemia. We found that most pyloric obstruction was related to the operative approaches and operation performing, so we made innovations to improve these approaches such as:1. fix the gastric to the diaphgram during Ivor-lewis esophagectomy2. sufficient free of the gastric and the adhension band when a high-leve anastomosis was needed.3. pay attention to the operation and evade the stimulation to the gastric. After adopting these measures, from Jan2006--Jun2012, only2polyric obstruction was obsevred in861patients accepted esophagecotomy, in which1patients accepted left transthorcic approaches with anastomosis above the atora arch and1patients accepted left transthorcic approaches with anastomosis in the neck.Conclusion:we consider that the the operative approaches and operation performing, were the main reasons to cause pyloric obstruction. Chooseing the optimal operative approachs and careful operative performing could significantly decline the incidence rate of pyloric obstruction.