Rosato E F, Acker M, Curcillo P G, Reilly R, Reynolds J
Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia.
Surg Gynecol Obstet. 1991 Aug;173(2):137-41.
The most common surgical treatment for achalasia is a modified anterior extramucosal esophagomyotomy. Unfortunately, a poor outcome may result secondary to recurrent dysphagia or gastroesophageal reflux. The reported incidence of reflux is 4 to 50 per cent. Our treatment for achalasia is an esophagomyotomy carried onto the cardia combined with a partial gastric fundoplication. Of 22 patients who presented with achalasia and moderate to severe symptoms of dysphagia and odynophagia, 19 had this procedure performed. Of these 19 patients, only two required a second procedure (postoperative dilatation) for recurrent symptoms. All three patients who had a full fundoplication required further surgical correction. Although fundoplication has been condemned in the past as treatment of achalasia to avoid the postoperative outcome of reflux, we have been successful with a partial fundoplication added to the standard esophagomyotomy. Given the fine line that needs to be tread to prevent recurrent signs and symptoms of achalasia or reflux when performing esophagomyotomy, our procedure offers a viable alternative to transthoracic esophagomyotomy alone.
贲门失弛缓症最常见的外科治疗方法是改良的经胸外黏膜下食管肌层切开术。不幸的是，由于复发性吞咽困难或胃食管反流，可能会导致预后不良。报道的反流发生率为4%至50%。我们治疗贲门失弛缓症的方法是将食管肌层切开术延伸至贲门，并联合部分胃底折叠术。在22例表现为贲门失弛缓症且有中度至重度吞咽困难和吞咽痛症状的患者中，19例接受了该手术。在这19例患者中，只有2例因复发症状需要进行第二次手术（术后扩张）。所有3例行完全胃底折叠术的患者都需要进一步的手术矫正。尽管过去胃底折叠术作为贲门失弛缓症的治疗方法因会导致术后反流而受到谴责，但我们在标准食管肌层切开术基础上联合部分胃底折叠术取得了成功。鉴于在进行食管肌层切开术时需要谨慎权衡以防止贲门失弛缓症或反流的复发体征和症状，我们的手术为单纯经胸食管肌层切开术提供了一种可行的替代方法。
