Bonventre S, Frazzetta M, Lucania M, Frazzetta F, Sciortino A S, Sammartano D, Vetri G, Di Gesù G
Università degli Studi di Palermo, Policlinico Paolo Giaccone, Dipartimento di Discipline Chirurgiche ed Oncologiche, Cattedra di Chirurgia Generale e Fisiopatologia chirurgica.
G Chir. 2008 Aug-Sep;29(8-9):373-7.
The authors report their experience about the intraoperative manometry in the achalasia surgical treatment.
We have considered 239 patients with achalasia observed from 1994 to 2006; only 79 continued the path diagnostic therapeutic and 31 underwent Heller longitudinal miotomy, with Dor anti-reflux plastic in 25 patients and in 6 Nissen anti-reflux plastic. In 24 we performed the intraoperative manometry (MI) recording the high pressure areas.
The patients underwent Heller's procedure with manometric check of the gastric muscular fibre sectioned areas reported the disappearance of the dysphagia. Three of the operated ones without using the MI complained about the persistence of mild dysphagia and it did not depend from the antireflux surgical procedure used.
Our findings confirm that the extramucosal miotomy is the treatment of choice for the achalasia and suggest that by MI a complete miotomy is allowed mostly on the gastric side where the muscular fibres get an important role in the maintenance of the high pressure areas.
作者报告了他们在贲门失弛缓症手术治疗中进行术中测压的经验。
我们纳入了1994年至2006年间观察的239例贲门失弛缓症患者；只有79例继续接受诊断性治疗，31例行Heller纵行肌切开术，其中25例采用Dor抗反流成形术，6例采用Nissen抗反流成形术。24例患者术中进行了测压（MI）以记录高压区域。
接受Heller手术并对胃肌纤维切断区域进行测压检查的患者吞咽困难消失。3例未进行MI的手术患者仍有轻度吞咽困难，且这与所采用的抗反流手术无关。
我们的研究结果证实，黏膜外肌切开术是贲门失弛缓症的首选治疗方法，并表明通过MI大多能在胃侧实现完全肌切开术，胃侧的肌纤维在维持高压区域中起重要作用。
