Omura Nobuo, Kashiwagi Hideyuki, Tsuboi Kazuto, Ishibashi Yoshio, Kawasaki Naruo, Yano Fumiaki, Suzuki Yutaka, Yanaga Katsuhiko
Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
Surg Today. 2006;36(3):235-40. doi: 10.1007/s00595-005-3122-4.
The therapeutic effects of a laparoscopic Heller myotomy and Dor fundoplication (LHD) on the chest pain associated with achalasia were investigated.
Sixty-six patients who were diagnosed to have achalasia underwent LHD. The degree of dilatation was assessed based on the maximum horizontal diameter of the esophagus (Grades I-III). The type of dilatation was assessed based on the shape of the distal esophagus, namely, spindle type (Sp), flask type (Fk), and sigmoid type (Sig). The degree of improvement was classified into three grades as follows: A (complete disappearance), B (partial response), and C (unchanged).
Chest pain improved (A or B) in 22 patients (92%). The statistical results revealed that the improvement of postoperative A or B was significantly better in patients with Sp than in those with Fk or Sig (P = 0.0213). In addition, the results revealed that the improvement of postoperative A or B was significantly better in patients with grade I and grade II than in those with grade III (P = 0.004).
LHD is an effective therapeutic technique for the treatment of chest pain associated with achalasia. These results suggest that both the morphological type and esophageal dilatation are useful predictors for the improvement of chest pain after surgical therapy.
研究腹腔镜下贲门肌层切开术联合Dor胃底折叠术（LHD）治疗贲门失弛缓症相关胸痛的疗效。
66例被诊断为贲门失弛缓症的患者接受了LHD治疗。根据食管最大横径评估扩张程度（I - III级）。根据食管远端形状评估扩张类型，即纺锤型（Sp）、烧瓶型（Fk）和乙状结肠型（Sig）。改善程度分为以下三个等级：A（完全消失）、B（部分缓解）和C（无变化）。
22例患者（92%）胸痛得到改善（A或B）。统计结果显示，Sp型患者术后A或B的改善明显优于Fk型或Sig型患者（P = 0.0213）。此外，结果显示，I级和II级患者术后A或B的改善明显优于III级患者（P = 0.004）。
LHD是治疗贲门失弛缓症相关胸痛的有效治疗技术。这些结果表明，形态类型和食管扩张程度都是手术治疗后胸痛改善的有用预测指标。
