Pellegrini C, Wetter L A, Patti M, Leichter R, Mussan G, Mori T, Bernstein G, Way L
Department of Surgery, University of California, San Francisco 94143-0788.
Ann Surg. 1992 Sep;216(3):291-6; discussion 296-9. doi: 10.1097/00000658-199209000-00008.
The authors treated 17 patients with achalasia by a thoracoscopic (15 patients) or laparoscopic (2 patients) Heller myotomy. All patients had dysphagia and an upper gastrointestinal series demonstrating a dilated esophagus with a bird-beak deformity at the cardia. Manometry showed a mean lower esophageal sphincter (LES) pressure of 32 +/- 4 mmHg, incomplete sphincter relaxation on swallowing, and no primary esophageal peristalsis. After operation, mean LES pressure was 10 +/- 2 mmHg. Fifteen patients were fed on the second postoperative day. The average hospital stay was 3 days, and there were no deaths or major complications. In three early patients, the myotomy was not carried far enough onto the stomach, and dysphagia persisted until a second myotomy was performed (laparoscopically in two patients). The authors found that having an endoscope in the esophagus during the operation facilitated exposure and was vital to determine the appropriate length of the myotomy. With regard to dysphagia, final results were excellent in 12 patients (70%), good in two patients (12%), fair in two patients (12%), and poor in one patient (6%). Heller myotomy can be safely and reliably performed with minimally invasive techniques. Dysphagia is relieved, postoperative pain is minimal, hospital stay is short, and the patient can return quickly to normal activity.
作者采用胸腔镜手术（15例）或腹腔镜手术（2例）对17例贲门失弛缓症患者进行了Heller肌切开术。所有患者均有吞咽困难，上消化道造影显示食管扩张，贲门处呈鸟嘴样畸形。食管测压显示食管下括约肌（LES）平均压力为32±4 mmHg，吞咽时括约肌松弛不完全，且无原发性食管蠕动。术后LES平均压力为10±2 mmHg。15例患者术后第二天开始进食。平均住院时间为3天，无死亡或严重并发症发生。在早期的3例患者中，肌切开术未充分延伸至胃部，吞咽困难持续存在，直至再次进行肌切开术（2例为腹腔镜手术）。作者发现，手术过程中食管内放置内镜有助于暴露视野，对于确定肌切开术的合适长度至关重要。关于吞咽困难，最终结果为：12例患者（70%）极佳，2例患者（12%）良好，2例患者（12%）尚可，1例患者（6%）较差。Heller肌切开术可通过微创技术安全、可靠地进行。吞咽困难得以缓解，术后疼痛轻微，住院时间短，患者可迅速恢复正常活动。
