Perrault L, Beauchamp G, Bastien E, Laurendeau F, Jobin G, Archambault A
Division of General Surgery, Hôpital Maisonneuve-Rosemont, Montreal, Que.
Can J Surg. 1991 Oct;34(5):487-90.
The authors report their experience with 43 patients treated for achalasia of the esophagus in a general hospital between 1971 and 1986. Patients were divided into two groups according to the type of surgery performed: group 1--29 patients treated by Heller myotomy, performed by nine general surgeons between 1971 and 1983; and group 2--14 patients treated by transthoracic Heller myotomy with the addition of a Belsey Mark-IV fundoplication. Dysphagia was reduced postoperatively in 82.6% of patients in group 1 and 92.8% of patients in group 2. Three patients in group 1 and one patient in group 2 had persistent dysphagia. Ten patients in group 1 had symptoms of gastroesophageal reflux (5 of them required a second antireflux procedure). In group 2, one patient had symptoms of gastroesophageal reflux, but was treated successfully medically. There was no difference in the degree of relief of dysphagia between the abdominal and thoracic approach, or in whether the operation was performed by a general surgeon without specific experience in the treatment of achalasia. The addition of a fundoplication to a Heller myotomy appeared to lessen the problem of postoperative gastroesophageal reflux. Since the Heller myotomy is technically difficult and may lead to obstruction of the poorly emptying esophagus the authors recommend that it be used selectively and only by the experienced esophageal surgeon.
作者报告了他们在1971年至1986年间于一家综合医院治疗43例食管贲门失弛缓症患者的经验。根据所施行的手术类型，患者被分为两组：第1组——29例患者接受了由9位普通外科医生在1971年至1983年间施行的Heller肌层切开术；第2组——14例患者接受了经胸Heller肌层切开术并附加Belsey Mark-IV胃底折叠术。第1组82.6%的患者和第2组92.8%的患者术后吞咽困难有所减轻。第1组有3例患者和第2组有1例患者仍存在持续性吞咽困难。第1组有10例患者出现胃食管反流症状（其中5例需要再次进行抗反流手术）。在第2组中，有1例患者出现胃食管反流症状，但通过药物治疗成功治愈。腹部入路和胸部入路在吞咽困难缓解程度上没有差异，由没有食管贲门失弛缓症治疗经验的普通外科医生施行手术与否也无差异。在Heller肌层切开术基础上加做胃底折叠术似乎减轻了术后胃食管反流问题。由于Heller肌层切开术技术难度较大，且可能导致排空不良的食管梗阻，作者建议应选择性地使用该手术，并且仅由经验丰富的食管外科医生施行。
