Gockel Ines, Junginger Theodor, Eckardt Volker F
Department of General and Abdominal Surgery, Johannes Gutenberg-University of Mainz, and the Department of Gastroenterology, German Diagnostic Clinic, Wiesbaden, Germany.
J Gastrointest Surg. 2006 Dec;10(10):1400-8. doi: 10.1016/j.gassur.2006.07.006.
Myotomy has proved to be an efficient primary therapy in patients with achalasia, especially in younger patients (<40 years of age). The results of laparoscopic myotomy cannot be finally assessed, on account of the shorter postoperative follow-up. Thus, there are considerable data regarding intermediate-term outcomes after laparoscopic myotomy. The aim of our study was a 20-year analysis of the conventional cardiomyotomy as the underlying basis assessing the results of minimal-invasive surgery. Within 20 years (September 1985 through September 2005), 161 operations for achalasia were performed in our clinic. Enrolled in this study were 108 patients with a conventional, transabdominal myotomy in combination with an anterior semifundoplication (Dor procedure) and a minimal follow-up of 6 months. All patients were prospectively followed and, in addition to radiologic and manometric examinations of the esophagus, the patients were asked for their clinical symptoms by structured interviews in 2-year intervals. The median age at the time of surgery was 44.5 (range, 14-78) years, and 72.2% of the patients were males. The median length of the preoperative symptoms was 3 years (3 months to 50 years), and the postoperative follow-up was 55 (range, 6-206) months. In 70 (64.8%) patients, a pneumatic dilation had been performed. The preoperative Eckardt score of 6 (range, 2-12) could be reduced to 1 (range, 0-4) after myotomy (P<0.0001). Consequently, with 97.2% of all patients, a good-to-excellent result was achieved in the long-term follow-up, corresponding to a clinical stage I-II. Postoperatively, 69 patients (63.9%) gained weight. The radiologically measured maximum diameter of the esophagus decreased from preoperatively 45 (range, 20-75) mm to postoperatively 30 (range, 20-60) mm, while the minimum diameter of the cardia increased from 3.4 (range, 1-10) mm to 10 (range, 5-15) mm. The resting pressure of the lower esophageal sphincter could be reduced from 28.4 (range, 9.4-56.0) mm Hg to 8.6 (range, 3.0-22.5) mm Hg. Conventional myotomy leads in the long run with high efficiency to an improvement of the symptoms evident in achalasia. These results may be regarded as the basis for assessment of the minimal-invasive procedure.
肌切开术已被证明是治疗贲门失弛缓症患者的一种有效的主要治疗方法，尤其是对于年轻患者（<40岁）。由于术后随访时间较短，腹腔镜肌切开术的结果尚不能最终评估。因此，关于腹腔镜肌切开术后中期结果有大量数据。我们研究的目的是对传统贲门肌切开术进行20年的分析，以此作为评估微创手术结果的基础。在20年（1985年9月至2005年9月）内，我们诊所共进行了161例贲门失弛缓症手术。本研究纳入了108例行传统经腹肌切开术联合前半胃底折叠术（Dor手术）且最短随访6个月的患者。所有患者均进行前瞻性随访，除了对食管进行放射学和测压检查外，还通过每2年一次的结构化访谈询问患者的临床症状。手术时的中位年龄为44.5岁（范围14 - 78岁），72.2%的患者为男性。术前症状的中位持续时间为3年（3个月至50年），术后随访时间为55个月（范围6 - 206个月）。70例（64.8%）患者曾接受过气囊扩张术。肌切开术后，术前的埃卡德特评分为6分（范围2 - 12分）可降至1分（范围为0 - 4分）（P<0.0001）。因此，在长期随访中，97.2%的患者取得了良好至优秀的结果，相当于临床I - II期。术后，69例（63.9%）患者体重增加。食管放射学测量的最大直径从术前的45毫米（范围20 - 75毫米）降至术后的30毫米（范围20 - 60毫米），而贲门的最小直径从术前的3.4毫米（范围1 - 10毫米）增加到10毫米（范围5 - 15毫米）。食管下括约肌的静息压力可从28.4毫米汞柱（范围9.4 - 56.0毫米汞柱）降至8.6毫米汞柱（范围3.0 - 22.5毫米汞柱）。传统肌切开术从长远来看能高效改善贲门失弛缓症明显的症状。这些结果可被视为评估微创手术的基础。
