Panchanatheeswaran Karthik, Parshad Rajinder, Rohila Jitender, Saraya Anoop, Makharia Govind K, Sharma Raju
Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
Interact Cardiovasc Thorac Surg. 2013 Jan;16(1):49-54. doi: 10.1093/icvts/ivs427. Epub 2012 Oct 12.
It is generally believed that Heller's cardiomyotomy (HCM) cannot improve dysphagia in patients with marked dilatation and axis deviation or sigmoid oesophagus. Conventional management for sigmoid oesophagus has been oesophagectomy. We report our surgical experience in the management of 8 patients with sigmoid oesophagus with laparoscopic HCM.
Eight patients with sigmoid oesophagus were retrospectively identified and their records were reviewed for symptomatic outcome evaluation following laparoscopic HCM with an antireflux procedure. Preoperative and postoperative, oesophageal and respiratory symptoms and quality of life scoring of achalasia were recorded.
The mean age was 35.5 (range 25-57) years. Males and females were equally distributed. All patients had dysphagia as their chief presenting complaint. The median duration of dysphagia was 55 (range 18-180) months. All the patients had a poor quality of life. Four patients also had chronic cough. All 8 patients underwent laparoscopic HCM with an antireflux procedure. The mean duration of operation was 203.7 min. There were no mortalities and no major postoperative complications. At a median follow-up of 19.5 (range 6-45) months, there was a significant improvement of dysphagia and regurgitation scores with P-values of 0.014 and 0.008, respectively. Quality of life also significantly (P = 0.005) improved post-surgery. Chronic cough resolved in all the 4 patients (100%) following cardiomyotomy.
Laparoscopic HCM with an antireflux procedure provides significant symptom relief in patients with sigmoid oesophagus and may be considered as the first-line treatment option in such patients. Oesophagectomy should be reserved for patients with a failed cardiomyotomy.
人们普遍认为，赫勒肌层切开术（HCM）无法改善存在明显扩张和轴偏移或乙状结肠型食管的患者的吞咽困难。乙状结肠型食管的传统治疗方法是食管切除术。我们报告了我们对8例乙状结肠型食管患者行腹腔镜HCM的手术经验。
回顾性确定8例乙状结肠型食管患者，并对其记录进行回顾，以评估腹腔镜HCM联合抗反流手术后的症状结局。记录术前和术后的食管和呼吸道症状以及贲门失弛缓症的生活质量评分。
平均年龄为35.5岁（范围25 - 57岁）。男女分布均等。所有患者均以吞咽困难为主要主诉。吞咽困难的中位持续时间为55个月（范围18 - 180个月）。所有患者的生活质量都很差。4例患者还伴有慢性咳嗽。所有8例患者均接受了腹腔镜HCM联合抗反流手术。平均手术时间为203.7分钟。无死亡病例，也无重大术后并发症。中位随访19.5个月（范围6 - 45个月）时，吞咽困难和反流评分有显著改善，P值分别为0.014和0.008。生活质量在手术后也有显著改善（P = 0.005）。4例患者（100%）在肌层切开术后慢性咳嗽均消失。
腹腔镜HCM联合抗反流手术能显著缓解乙状结肠型食管患者的症状，可被视为这类患者的一线治疗选择。食管切除术应保留给肌层切开术失败的患者。
