Lewandowski A
Department of Gastroenterology and General Surgery, University of Medicine in Wroclaw, Wroclaw, Poland.
Dis Esophagus. 2009;22(4):305-9. doi: 10.1111/j.1442-2050.2008.00897.x. Epub 2008 Dec 22.
Megaesophagus is the end-stage of achalasia cardiae. It is the result of peristaltic disorders and slow decompensation of the muscular layer of the esophagus. The aim of this article is to detail the diagnostic criteria and surgical management of megaesophagus. Criteria were acute bending of esophagus axis; lack of esophagus peristalsis, and no response to stimulation in the manometric test; and Los Angeles C/D esophagitis in the endoscopic examination. Between 1991 and 2004 seven patients (5 females, 2 males; age, 51-67 years; average age, 59 +/- 8 years) were treated. A bypass made from the pedunculated part of the jejunum connecting the part of esophagus above the narrowing with the praepyloric part of the stomach was made. Access was by an abdominal approach. A jejunum bypass was made in six patients with megaesophagus. A transhiatal esophageal resection was carried out, and in the second stage a supplementary esophagus was made from the right half of the colon on the ileocolic vessels in one patient who had experienced two earlier unsuccessful operations. Symptoms of dysphagia, recurrent inflammation of the respiratory tract, and pain subsided in all patients. Complications were not reported in the postoperative period. All patients survived. Subsequent radiographic and endoscopic examination showed very good outcome. The jejunum bypass gave very good results in the surgical treatment of megaesophagus.
巨食管是贲门失弛缓症的终末期。它是食管蠕动障碍和食管肌层缓慢失代偿的结果。本文旨在详述巨食管的诊断标准及手术治疗方法。标准为食管轴急性弯曲；食管无蠕动，测压试验对刺激无反应；内镜检查见洛杉矶分级C/D级食管炎。1991年至2004年间，对7例患者（5例女性，2例男性；年龄51 - 67岁；平均年龄59±8岁）进行了治疗。制作了一个由空肠带蒂部分构成的旁路，将狭窄上方的食管部分与胃幽门前部相连。采用腹部入路。6例巨食管患者进行了空肠旁路手术。1例此前两次手术失败的患者，进行了经胸食管切除术，二期用回结肠血管上的右半结肠制作了补充食管。所有患者吞咽困难、呼吸道反复炎症及疼痛症状均消失。术后未报告并发症。所有患者均存活。随后的影像学和内镜检查显示效果非常好。空肠旁路术在巨食管的手术治疗中效果非常好。
