Rea S, Kelly C J, Broe P J
Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin 9.
Ir J Med Sci. 1999 Jan-Mar;168(1):10-2. doi: 10.1007/BF02939572.
Surgical myotomy is the mainstay of treatment for oesophageal achalasia. Minimally invasive surgical techniques, if feasible, reduce patient morbidity and mortality. In this study we review our experience of thoracoscopic Heller's myotomy. Thoracoscopic myotomy was undertaken in 9 patients (male = 3; female = 6, mean age = 37). All patients presented with dysphagia of 1 to 8 yr duration. Diagnosis was based on barium swallow and manometry. Two patients had previous dilatations and 1 had a transabdominal myotomy. All patients had a 5 port thoracoscopic technique. Thoracoscopic Heller's myotomy was completed in 8 out of 9 patients. In 1 patient extensive oesophagitis and peri-oesophagitis precluded both a thoracoscopic and an open myotomy, and oesophagectomy was subsequently performed. The mean duration of surgery was 142 min. Completion of myotomy and mucosal integrity was confirmed by intraoperative gastroscopy. All patients had an uneventful post-operative recovery. The mean hospital stay was 4 days. All patients are now asymptomatic, with documented weight gain. No patients have reflux oesophagitis symptoms. Our preliminary experience would suggest that thoracoscopic Heller's myotomy is a safe alternative to open surgery, with satisfactory results and reduced hospital stay.
手术肌切开术是治疗食管贲门失弛缓症的主要方法。如果可行，微创外科技术可降低患者的发病率和死亡率。在本研究中，我们回顾了我们的胸腔镜下Heller肌切开术的经验。对9例患者（男性3例；女性6例，平均年龄37岁）进行了胸腔镜肌切开术。所有患者均有1至8年的吞咽困难病史。诊断基于吞钡检查和食管测压。2例患者曾接受过扩张治疗，1例曾接受过经腹肌切开术。所有患者均采用5孔胸腔镜技术。9例患者中有8例完成了胸腔镜下Heller肌切开术。1例患者因广泛的食管炎和食管周围炎而无法进行胸腔镜和开放肌切开术，随后进行了食管切除术。平均手术时间为142分钟。术中胃镜检查证实肌切开术完成且黏膜完整。所有患者术后恢复顺利。平均住院时间为4天。所有患者目前均无症状，体重有记录增加。无患者出现反流性食管炎症状。我们的初步经验表明，胸腔镜下Heller肌切开术是开放手术的一种安全替代方法，效果满意且住院时间缩短。
