Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
Surg Endosc. 2010 Jan;24(1):40-4. doi: 10.1007/s00464-009-0513-4. Epub 2009 Jun 4.
Oesophageal achalasia is a rare disorder in childhood. Common treatments in adults include oesophageal cardiomyotomy (laparoscopic or open) with fundoplication. We aimed to assess the results of laparoscopic oesophageal cardiomyotomy without fundoplication for treatment of achalasia in children.
We reviewed the results of laparoscopic oesophageal cardiomyotomy between January 1998 and June 2008. Patients below the age of 18 years, who had undergone laparoscopic oesophageal cardiomyotomy without an anti-reflux procedure by a single surgeon, were identified. Data were collected from patient notes. Results are reported as median (range).
There were 20 patients (13 males and 7 females). Median age at surgery was 12 years (5-15 years) and weight was 38 kg (15-53 kg). Median duration of symptoms before surgery was 2.4 years (1.5-5 years). Duration of surgery was 96 min (60-160 min). Four patients (20%) required conversion to the open technique. In the remaining 16 children, fluids were started at a median of 7 h (6-8 h) post-operatively, and solid feeds were commenced at 22 h (20-24 h). Median length of hospital stay was 3 days (1-5 days). Median length of follow-up was 60 months (8-114 months). None of the patients had evidence of gastro-oesophageal reflux post-operatively. Five patients (25%) continued to experience dysphagia, with one of them also experiencing vomiting. Two patients were found to have oesophageal stricture and three patients were found to have oesophageal dysmotility. The remaining patients are asymptomatic.
These results suggest that laparoscopic oesophageal cardiomyotomy is a valid treatment in children with achalasia. In our experience, an adjunctive anti-reflux procedure is not required, as there was no evidence of post-operative gastro-oesophageal reflux in all patients. Oesophageal stricture and dysmotility account for residual post-operative symptoms.
食管失弛缓症在儿童中较为罕见。成人常见的治疗方法包括食管肌切开术（腹腔镜或开放）加胃底折叠术。我们旨在评估腹腔镜食管肌切开术不伴胃底折叠术治疗儿童贲门失弛缓症的效果。
我们回顾了 1998 年 1 月至 2008 年 6 月期间行腹腔镜食管肌切开术的结果。通过一名外科医生行腹腔镜食管肌切开术且未行抗反流手术的年龄小于 18 岁的患者被确定。从患者病历中收集数据。结果以中位数（范围）表示。
共有 20 名患者（男 13 例，女 7 例）。手术时的中位年龄为 12 岁（5-15 岁），体重为 38kg（15-53kg）。中位术前症状持续时间为 2.4 年（1.5-5 年）。手术时间为 96min（60-160min）。4 例（20%）需要转为开放手术。在其余 16 例患儿中，术后中位开始进液时间为 7h（6-8h），中位开始进固体食物时间为 22h（20-24h）。中位住院时间为 3 天（1-5 天）。中位随访时间为 60 个月（8-114 个月）。所有患儿术后均无胃食管反流证据。5 例（25%）患儿仍有吞咽困难，其中 1 例患儿还有呕吐。2 例患儿发现食管狭窄，3 例患儿发现食管动力障碍。其余患儿无症状。
这些结果表明，腹腔镜食管肌切开术是治疗儿童贲门失弛缓症的有效方法。根据我们的经验，不需要辅助抗反流手术，因为所有患儿均无术后胃食管反流证据。食管狭窄和动力障碍导致术后残留症状。
