Ducerf C, Baulieux J, Caillon P, Pouyet M
Clinique chirurgicale A, Hôpital de la Croix-Rousse, Lyon.
Chirurgie. 1990;116(8-9):791-5; discussion 795-6.
36 patients with peptic strictures were operated between 1981 and 1987. 40 operations performed because 4 recurrences after a first intervention obliged to a re-operation. The conservative procedure was used in 29 cases (72.5%). A resection had to be done in 11 cases (27.5%), with 3 re-operations after a first conservative treatment. 1 patient died in hospital. The follow up concerns all patient after a minimum of 2 years. 31 patients (88%) remained symptom free, but 4 patients required further surgery. No mortality and a low morbidity with conservative surgical method were observed. The rate of success was 76% with 24% of recurrence. For us, the best conservative method is total fundoplicatio if possible (sometimes on a gastric cone in case of reflux stricture with shortening of the esophagus). The duodenal diversion is recommended if approach of hiatus is too difficult (re-operation) and in case of alkaline reflux.
1981年至1987年间，对36例消化性狭窄患者进行了手术。共进行了40次手术，因为首次干预后有4例复发，不得不再次手术。29例（72.5%）采用了保守手术。11例（27.5%）不得不进行切除手术，其中3例在首次保守治疗后再次手术。1例患者死于医院。所有患者至少随访2年。31例（88%）患者无症状，但4例患者需要进一步手术。保守手术方法未观察到死亡率，发病率也较低。成功率为76%，复发率为24%。对我们来说，如果可能的话，最好的保守方法是全胃底折叠术（有时对于食管缩短的反流性狭窄，在胃圆锥上进行）。如果裂孔入路太难（再次手术）以及存在碱性反流的情况下，建议进行十二指肠转流术。
