Hunt D R, Wills V L, Weis B, Jorgensen J O, DeCarle D J, Coo I J
Department of Upper Gastrointestinal Surgery, St. George Hospital, Sydney, Australia.
J Gastrointest Surg. 2000 Jul-Aug;4(4):411-5. doi: 10.1016/s1091-255x(00)80021-9.
Current management of esophageal perforation after pneumatic dilation for achalasia is thoracotomy and repair with myotomy. This study aims to assess the outcome of patients managed by laparotomy, and the role of laparoscopic repair. The study was carried out by means of retrospective case review and prospective follow-up with a symptom questionnaire. Results were compared with results in patients undergoing elective Heller myotomy. Over a 20-year period, 445 dilations for achalasia were performed in 371 patients. There were 10 esophageal perforations. Nine patients were referred for surgery and were successfully managed with a transabdominal repair. Laparoscopic repair was attempted in four patients but was successful in only one because of the perforation site. After a mean follow-up of 5.4 years, grade 1 or 2 Visick scores were recorded in all patients. Residual symptoms of dysphagia occurred in 67% in the emergency group and 88% in the elective group. There was an increased incidence of heart-burn compared to elective myotomy. Early operation after perforation provides good results for treatment of achalasia. Mild dysphagia persists and there is an increasing sensation of heartburn. The site of perforation is typically posterolateral, which makes laparoscopic repair difficult.
目前针对贲门失弛缓症行气囊扩张术后食管穿孔的治疗方法是开胸手术并进行肌切开术修复。本研究旨在评估经剖腹手术治疗的患者的结局以及腹腔镜修复的作用。该研究通过回顾性病例分析和使用症状问卷进行前瞻性随访来开展。将结果与接受择期 heller 肌切开术的患者的结果进行比较。在 20 年期间，对 371 例患者进行了 445 次贲门失弛缓症扩张术。发生了 10 例食管穿孔。9 例患者被转诊进行手术，并通过经腹修复成功治疗。4 例患者尝试进行腹腔镜修复，但由于穿孔部位的原因，仅 1 例成功。平均随访 5.4 年后，所有患者均记录为 1 级或 2 级 Visick 评分。急诊组 67%的患者和择期组 88%的患者出现吞咽困难的残留症状。与择期肌切开术相比，烧心的发生率有所增加。穿孔后早期手术对贲门失弛缓症的治疗效果良好。轻度吞咽困难持续存在，烧心感增加。穿孔部位通常在食管后外侧，这使得腹腔镜修复困难。
