Alves A, Perniceni T, Godeberge P, Mal F, Lévy P, Gayet B
Medicosurgical Digestive Disease Unit, Montsouris Institute, Paris 6 University, 6 place de Port au Prince, 75013 Paris, France.
Surg Endosc. 1999 Jun;13(6):600-3. doi: 10.1007/s004649901050.
Inappropriate length of the myotomy incision along the stomach, the most common technical fault during Heller's cardiomyotomy, is related to the difficulty of identifying the gastro-esophageal junction, in particular during laparoscopic surgery. The goal of this study was to evaluate the contribution of endoscopy to gastro-esophageal junction identification during laparoscopic Heller's cardiomyotomy.
In a group of 19 patients with intraoperative endoscopy with laparoscopic Heller's cardiomyotomy, surgical and endoscopic criteria for gastro-esophageal junction identification have been assessed. Then postoperative results of this group were compared with those of another group of 16 patients previously operated on without intraoperative endoscopy.
Endoscopic and laparoscopic criteria for gastro-esophageal junction identification were discordant in 11 patients (11/19, 58%). The cardia was in all these cases at a more distal site with endoscopic criteria. Complications ascribable to suboptimal technique were more frequent in the group without intraoperative endoscopy (7/16 patients) than in the other group (2/19 patients).
Endoscopy during laparoscopic Heller's cardiomyotomy is of great assistance in identifying the cardia, and thereby could improve surgical outcomes.
在海勒贲门肌切开术中，最常见的技术失误是胃肌切开切口长度不当，这与识别胃食管交界处的困难有关，尤其是在腹腔镜手术中。本研究的目的是评估内镜检查在腹腔镜海勒贲门肌切开术中对识别胃食管交界处的作用。
在一组19例行腹腔镜海勒贲门肌切开术并术中进行内镜检查的患者中，评估了识别胃食管交界处的手术和内镜标准。然后将该组患者的术后结果与另一组16例未进行术中内镜检查的患者的结果进行比较。
11例患者（11/19，58%）的内镜和腹腔镜识别胃食管交界处的标准不一致。在所有这些病例中，根据内镜标准，贲门位于更远端的位置。未进行术中内镜检查的组（7/16例患者）中因技术欠佳导致的并发症比另一组（2/19例患者）更常见。
腹腔镜海勒贲门肌切开术中的内镜检查对识别贲门有很大帮助，从而可以改善手术效果。
