Department for Esophagogastric Surgery, First Surgical University Hospital, Clinical Center of Serbia, Koste Todorovića St 6, 11.000 Belgrade, Serbia.
J Gastrointest Surg. 2010 Apr;14(4):587-93. doi: 10.1007/s11605-009-1135-9. Epub 2009 Dec 22.
It is speculated that postoperative pathologic gastroesophageal reflux after Heller's myotomy can be diminished if the lateral and posterior phrenoesophageal attachments are left intact. The aim of this study was to evaluate the effectiveness of limited hiatal dissection in patients operated due to achalasia.
Prospective, randomized, 3 years follow-up of 84 patients operated due to achalasia. In 26 patients, Heller-Dor with complete hiatal dissection was done (G1), limited hiatal dissection combined with myotomy and Dor's procedure was performed in 36 patients (G2), and with Heller's myotomy alone in 22 (G3). Stationary manometry and 24 h pH study were performed in regular postoperative intervals.
Postoperatively, higher median values of lower esophageal sphincter resting pressures were marked in G2 and G3, while patients in G1 were presented with higher median values of pH acid score (p < 0.001). Abnormal DeMeester score 3 years after surgery was present in 23.1% of patients in G1 and 8.5% and 9.1% in G2 and G3 accordingly. There was no statistical difference between the groups concerning postoperative dysphagia recurrence.
Indicating further long-term studies, 3 years after the operation limited hiatal dissection compared to complete obtains better reflux control in achalasia patients, regardless of Dor's fundoplication.
有人推测，如果保留膈食管侧后附着处，Heller 肌切开术后的病理性胃食管反流可以减少。本研究旨在评估在贲门失弛缓症患者中进行有限的食管裂孔切开术的效果。
前瞻性、随机、3 年随访 84 例贲门失弛缓症患者。26 例患者行 Heller-Dor 完全食管裂孔切开术（G1 组），36 例患者行有限食管裂孔切开术联合肌切开术和 Dor 手术（G2 组），22 例患者行 Heller 肌切开术（G3 组）。常规术后间隔进行静止测压和 24 h pH 研究。
术后，G2 和 G3 组的食管下括约肌静息压力中位数较高，而 G1 组的 pH 酸评分中位数较高（p < 0.001）。术后 3 年，G1 组有 23.1%的患者出现异常 DeMeester 评分，G2 组和 G3 组分别为 8.5%和 9.1%。三组间术后吞咽困难复发无统计学差异。
进一步的长期研究表明，与完全食管裂孔切开术相比，3 年后有限的食管裂孔切开术在贲门失弛缓症患者中能更好地控制反流，与 Dor 胃底折叠术无关。
