Ackroyd R, Watson D I, Devitt P G, Jamieson G G
Department of Surgery, Royal Adelaide Hospital, University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia.
Surg Endosc. 2001 Jul;15(7):683-6. doi: 10.1007/s004640080037. Epub 2001 May 7.
Although surgical myotomy is considered the gold standard, many different treatments have been advocated for achalasia. There are now a number of reports of cardiomyotomy being performed laparoscopically.
This is a prospective study of 82 patients (47 male and 35 female; median age, 47 years) who underwent laparoscopic cardiomyotomy and anterior partial fundoplication for achalasia.
Four of the 82 procedures required conversion to open surgery, all during the early stages of the series, and two required early reoperation for a postoperative problem. The median operating time was 80 min (range, 32-210). the median hospital stay was 3 days (range, 2-18), and normal physical activity was resumed after a median of 2 weeks (range, 3 days to 12 weeks). Follow-up ranged up to 8 years (median, 2). Postoperatively, symptoms of dysphagia (to both solids and liquids), heartburn, odynophagia, chest pain, regurgitation, and cough were significantly reduced in all patients. The median overall satisfaction score (graded from 0 to 10, with 10 representing total satisfaction) was 9 (range, 0-10), and 90% of patients were highly satisfied with the surgical outcome.
Laparoscopic cardiomyotomy with anterior partial fundoplication achieves excellent symptomatic relief for patients with achalasia, and it can be performed with minimal morbidity.
尽管手术肌切开术被认为是金标准，但针对贲门失弛缓症已有多种不同的治疗方法被提倡。现在有许多关于腹腔镜下进行贲门肌切开术的报道。
这是一项对82例患者（47例男性和35例女性；中位年龄47岁）进行的前瞻性研究，这些患者因贲门失弛缓症接受了腹腔镜贲门肌切开术和前位部分胃底折叠术。
82例手术中有4例需要转为开放手术，均在该系列手术的早期阶段，另外2例因术后问题需要早期再次手术。中位手术时间为80分钟（范围32 - 210分钟）。中位住院时间为3天（范围2 - 18天），中位2周（范围3天至12周）后恢复正常体力活动。随访时间长达8年（中位时间2年）。术后，所有患者的吞咽困难（固体和液体）、烧心、吞咽痛、胸痛、反流和咳嗽症状均显著减轻。总体满意度中位评分（从0到10分，10分表示完全满意）为9分（范围0 - 10分），90%的患者对手术结果高度满意。
腹腔镜贲门肌切开术联合前位部分胃底折叠术能为贲门失弛缓症患者带来极佳的症状缓解，且手术并发症发生率极低。
