腹腔镜治疗贲门失弛缓症经胸肌切开术后复发性吞咽困难。
Laparoscopic treatment of recurrent dysphagia following transthoracic myotomy for achalasia.
作者信息
Robinson Thomas N, Galvani Carlos A, Dutta Sanjoy K, Gorodner Maria V, Patti Marco G
机构信息
Department of Surgery, University of California, San Francisco, San Francisco, California.
出版信息
J Laparoendosc Adv Surg Tech A. 2003 Dec;13(6):401-3. doi: 10.1089/109264203322656487.
BACKGROUND
The choice of treatment of recurrent dysphagia following transthoracic myotomy is unclear. Often pneumatic dilatation is tried first, followed by esophagectomy in case of failure. We propose laparoscopic Heller myotomy as an alternative treatment for this group of patients.
METHODS
Three patients underwent laparoscopic Heller myotomy for the treatment of recurrent dysphagia following transthoracic myotomy. The patients had undergone an average of 7 pneumatic dilatations (range, 2 to 10) prior to referral for surgery, without resolution of their dysphagia.
RESULTS
All patients successfully underwent a laparoscopic myotomy on the right side of the esophagus with a Dor fundoplication. Good or excellent results were achieved in all patients. Average followup was 18 months.
CONCLUSIONS
Laparoscopic Heller myotomy is a very effective treatment for patients who experience recurrent dysphagia following a transthoracic myotomy.
背景
经胸肌切开术后复发性吞咽困难的治疗选择尚不清楚。通常首先尝试气囊扩张术，若失败则行食管切除术。我们提出腹腔镜下Heller肌切开术可作为这类患者的替代治疗方法。
方法
3例患者因经胸肌切开术后复发性吞咽困难接受了腹腔镜下Heller肌切开术。这些患者在转诊手术前平均接受了7次气囊扩张术（范围为2至10次），但其吞咽困难仍未缓解。
结果
所有患者均成功在食管右侧进行了腹腔镜肌切开术并加做了Dor胃底折叠术。所有患者均取得了良好或极佳的效果。平均随访时间为18个月。
结论
腹腔镜下Heller肌切开术对于经胸肌切开术后出现复发性吞咽困难的患者是一种非常有效的治疗方法。
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