Salo J A, Ala-Kulju K V, Heikkinen L O, Kivilaakso E O
Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.
J Thorac Cardiovasc Surg. 1991 Apr;101(4):649-53.
Eleven patients with dysphagia caused by severe esophageal stricture (length 2 to 10 cm) resulting from reflux esophagitis were treated with fibroendoscopic dilation (Eder-Puestow) and Roux-en-Y partial gastrectomy with vagotomy during 10 years (1979 to 1988). There was no operative mortality, but complications developed in three patients: One patient had a mediastinal abscess demanding thoracotomy as a result of esophageal perforation after dilatation; one had postoperative pneumonia; and one patient had ileus. After a mean follow-up of 4 years (range 1 to 10 years) esophagitis healed in all cases, as judged by endoscopy. Eight patients were asymptomatic, but three had slight transient dysphagia. Postoperatively one to eight dilations (average three to four) were needed to relieve dysphagia in the first postoperative year, but later the stricture healed in every case. Postoperative pH measurement was performed in six latest patients and showed complete absence of reflux in all cases. It is concluded that Roux-en-Y partial gastrectomy with vagotomy and endoscopic dilation is an effective, simple, and safe procedure in the management of severe peptic esophageal (acid or alkaline esophagitis) stricture. However, occasional postoperative dilations at the outpatient clinic are often needed in severe cases in the first postoperative year.
在10年期间（1979年至1988年），对11例因反流性食管炎导致严重食管狭窄（长度2至10厘米）而出现吞咽困难的患者进行了纤维内镜扩张术（埃德尔-普斯托法）以及伴有迷走神经切断术的Roux-en-Y部分胃切除术。无手术死亡病例，但有3例出现了并发症：1例因扩张术后食管穿孔导致纵隔脓肿而需开胸手术；1例发生术后肺炎；1例出现肠梗阻。平均随访4年（范围1至10年）后，经内镜检查判断，所有病例的食管炎均已愈合。8例患者无症状，但3例有轻微短暂性吞咽困难。术后第1年，为缓解吞咽困难，1至8次扩张（平均3至4次），但后来所有病例的狭窄均愈合。对6例最新患者进行了术后pH值测量，结果显示所有病例均完全无反流。结论是，伴有迷走神经切断术的Roux-en-Y部分胃切除术及内镜扩张术是治疗严重消化性食管（酸性或碱性食管炎）狭窄的一种有效、简单且安全的方法。然而，在术后第1年，严重病例往往需要在门诊偶尔进行术后扩张。
