Altorjay Aron, Botos Balázs, Odor Sándor, Sárkány Agnes, Illés Iván, Varga István, Szilágyi Anna
Fejér Megyei Szent Gyôrgy Kórház Sebészeti Osztály, Székesfehérvár.
Orv Hetil. 2005 May 8;146(19):959-63.
Epiphrenic diverticulum cannot be considered a primary anatomical alteration, there is a manometrically verifiable motility disturbance in the background.
To determine the place, type and time of surgical solution in the treatment.
Between 1999 and 2004 seven patients were treated for epiphrenic diverticulum causing complaints. Average age was 61 years, and the leading symptom was dysphagia and regurgitation. Motility abnormalities characteristic of achalasia in four cases, hypertensive LES in three cases, and incompetent and normal LES, and diffuse esophageal spasm in one patient each could be revealed. The size of diverticuli varied between 5-9 cm.
In four cases transthoracic diverticulectomy myotomy and partial antireflux plasty, in two cases esophagus resection, and in the case of one patient myotomy and fundoplication was performed. In the removed diverticuli an ulcer and a malignant transformation in one case each was detected. No major complications could be observed. Six patients are completely satisfied with the operation, only one reported well tolerable occasional regurgitations.
Even in the era of minimal invasive surgery the traditionally performed, combined - diverticulectomy, myotomy, fundoplication - operative solution should be considered the gold standard. Surgical intervention is justified even for accidentally discovered symptomless patients, due to the considerable potential complications of the disease.
膈上憩室不能被视为一种原发性解剖改变，其背后存在可通过测压证实的动力障碍。
确定治疗中手术解决方案的部位、类型和时机。
1999年至2004年间，7例因膈上憩室出现症状的患者接受了治疗。平均年龄为61岁，主要症状为吞咽困难和反流。4例患者表现出贲门失弛缓症的典型动力异常，3例为高压性食管下括约肌，1例患者的食管下括约肌功能不全且正常，还有1例患者表现为弥漫性食管痉挛。憩室大小在5 - 9厘米之间。
4例行经胸憩室切除术、肌切开术和部分抗反流成形术，2例行食管切除术，1例行肌切开术和胃底折叠术。在切除的憩室中，各有1例发现溃疡和恶性转化。未观察到重大并发症。6例患者对手术完全满意，只有1例报告偶尔有可耐受的反流。
即使在微创手术时代，传统的联合手术方案——憩室切除术、肌切开术、胃底折叠术——仍应被视为金标准。由于该疾病存在相当大的潜在并发症，即使是偶然发现的无症状患者，手术干预也是合理的。
