Ahmed A, Yusufu L M D, Ukwenya Y A, Khalid L, Garba E S
Division of General Surgery, Ahmadu Bello University Hospital, Zaria, Nigeria.
S Afr J Surg. 2008 May;46(2):48-51.
Achalasia of the cardia is generally considered a rare disease. Because the cause is uncertain, treatment is palliative and directed at relieving distal oesophageal obstruction. In developed countries, several treatment options are available, but in developing countries, achalasia is usually treated by open surgical myotomy. We reviewed the outcome of management of achalasia in our patients and the influencing factors.
We retrospectively reviewed all adult patients treated for achalasia between 1991 and 2006. Diagnosis was based on clinical symptoms and barium swallow examination. The severity and frequency of dysphagia were determined before and after treatment. Barium examination was repeated 2 weeks after surgery or when the patient had recurrence of dysphagia, regurgitation or heartburn. Treatment was by modified Heller's operation, transabdominally without complementary antireflux procedure. Logistic regression modelling was performed to identify factors predictive of poor outcome.
There were 47 patients, 31 (66.0%) males and 16 females, mean age (+/- standard deviation (SD) 34.6+/-9.8 years. All patients presented with dysphagia, which was severe in 31 cases (66.0%) and moderate in 14 (29.8%). Preoperative maximum oesophageal diameter ranged from 34 to 89 mm, mean 67.4+/-12.7mm. In 30 (63.8%) of the patients, the maximum diameter was >70 mm. Postoperative maximum diameter ranged from 28 to 72 mm, mean 37.5+/-8.2 mm (p=0.001). The mean preoperative diameter of the narrowest distal oesophagus was 4.6+/-2.5 mm, compared with the postoperative figure of 11.6+/-1.8 mm (p=0.015). Following surgery, 41 (87.2%) patients had complete relief of dysphagia, regurgitation and heartburn. Four patients continued to have heartburn after surgery. Patients with severe dysphagia or preoperative oesophageal dilatation >70 mm had the greatest likelihood of incomplete relief of symptoms after treatment.
Achalasia can be accurately diagnosed on the basis of clinical symptoms and barium swallow examination. A modified Heller's operation provides lasting relief of symptoms. Patients with severe preoperative dysphagia or oesophageal dilatation are more likely to have poor outcome of treatment.
贲门失弛缓症通常被认为是一种罕见疾病。由于病因不明，治疗以姑息治疗为主，旨在缓解食管远端梗阻。在发达国家，有多种治疗选择，但在发展中国家，贲门失弛缓症通常通过开放性手术肌切开术进行治疗。我们回顾了我们患者贲门失弛缓症的治疗结果及影响因素。
我们回顾性分析了1991年至2006年间所有接受贲门失弛缓症治疗的成年患者。诊断基于临床症状和吞钡检查。在治疗前后确定吞咽困难的严重程度和频率。术后2周或患者出现吞咽困难、反流或烧心复发时重复进行钡剂检查。治疗采用改良的Heller手术，经腹进行，不进行抗反流辅助手术。进行逻辑回归建模以确定预后不良的预测因素。
共有47例患者，男性31例（66.0%），女性16例，平均年龄（±标准差）34.6±9.8岁。所有患者均有吞咽困难，其中31例（66.0%）严重，14例（29.8%）中度。术前食管最大直径为34至89mm，平均67.4±12.7mm。30例（63.8%）患者最大直径>70mm。术后最大直径为28至72mm，平均37.5±8.2mm（p=0.001）。术前最窄的食管远端平均直径为4.6±2.5mm，术后为11.6±1.8mm（p=0.015）。手术后，41例（87.2%）患者的吞咽困难、反流和烧心症状完全缓解。4例患者术后仍有烧心症状。术前吞咽困难严重或食管扩张>70mm的患者治疗后症状不完全缓解的可能性最大。
贲门失弛缓症可根据临床症状和吞钡检查准确诊断。改良的Heller手术可持久缓解症状。术前吞咽困难严重或食管扩张的患者治疗效果较差的可能性更大。
