Cortesini Camillo, Cianchi Fabio, Pucciani Filippo
Dipartimento di Area Critica Medico-Chirurgica Clinica Chirurgica Generale, Università degli Studi di Firenze.
Chir Ital. 2002 Sep-Oct;54(5):581-6.
Both open and laparoscopic myotomies have been used in the treatment of achalasia. Postoperative gastro-oesophageal reflux is among the commonly reported side effects of myotomy. The addition of an antireflux procedure to the standard surgical approach has given rise to controversy. The objective of our study was to determine whether or not an antireflux procedure should be used in addition to Heller myotomy. Over the period from 1980 to 1990, 94 patients (mean age: 47.9 years) with achalasia underwent Heller myotomy calibrated by intraoperative oesophageal manometry without fundoplication. In 1999-2000, all patients filled in a clinical questionnaire: all underwent radiographic oesophageal imaging, oesophageal manometry, ambulatory 24-h oesophageal pH monitoring, and oesophagogastroduodenoscopy, when necessary. Ten healthy age-matched subjects were compared in the manometric and radiological studies. Myotomy improved the clinical profiles and instrumental data results in all patients. Gastro-oesophageal reflux was present in 10 patients (10.6%); none of these 10 subjects presented oesophagitis. Heller open myotomy yields good long-term results. Intraoperative manometric calibration reduces the side effects of myotomy, such as gastro-oesophageal reflux. The addition of fundoplication is not justified in all patients.
开放性和腹腔镜下肌切开术均已用于贲门失弛缓症的治疗。术后胃食管反流是肌切开术常见的副作用之一。在标准手术方法中增加抗反流手术引发了争议。我们研究的目的是确定在海勒肌切开术之外是否应使用抗反流手术。在1980年至1990年期间，94例（平均年龄：47.9岁）贲门失弛缓症患者接受了术中食管测压校准的海勒肌切开术，未行胃底折叠术。在1999 - 2000年，所有患者填写了一份临床问卷：必要时均接受了食管影像学检查、食管测压、24小时动态食管pH监测以及食管胃十二指肠镜检查。在测压和放射学研究中与10名年龄匹配的健康受试者进行了比较。肌切开术改善了所有患者的临床症状和器械检查数据结果。10例患者（10.6%）存在胃食管反流；这10名受试者均未出现食管炎。开放性海勒肌切开术可产生良好的长期效果。术中测压校准可减少肌切开术的副作用，如胃食管反流。并非所有患者都有必要增加胃底折叠术。
