Pantanali Carlos A R, Herbella Fernando A M, Henry Maria A, Mattos Farah Jose Francisco, Patti Marco G
Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil.
Am Surg. 2013 Jan;79(1):72-5.
Laparoscopic Heller myotomy and fundoplication is considered today the treatment of choice for achalasia. The optimal treatment for end-stage achalasia with esophageal dilation is still controversial. This multicenter and retrospective study aims to evaluate the outcome of laparoscopic Heller myotomy in patients with a massively dilated esophagus. Eleven patients (mean age, 56 years; 6 men) with massively dilated esophagus (esophageal diameter greater than 10 cm) underwent a laparoscopic Heller myotomy and anterior fundoplication between 2000 and 2009 at three different institutions. Preoperative workup included upper endoscopy, esophagram, and esophageal manometry in all patients. Average follow-up was 31.5 months (range, 3 to 60 months). Two patients (18%) had severe dysphagia, four patients (36%) had mild and occasional dysphagia to solid food, and five patients (45%) were asymptomatic. All patients gained or kept body weight, except for the two patients with severe dysphagia. Of the two patients with severe dysphagia, one underwent esophageal dilatation and the other a laparoscopic esophagectomy. They are both doing well. Heller myotomy relieves dysphagia in the majority of patients even when the esophagus is massively dilated.
如今，腹腔镜下贲门肌切开术加胃底折叠术被认为是贲门失弛缓症的首选治疗方法。对于终末期贲门失弛缓症合并食管扩张的最佳治疗方法仍存在争议。这项多中心回顾性研究旨在评估腹腔镜下贲门肌切开术治疗食管重度扩张患者的疗效。2000年至2009年期间，11例食管重度扩张（食管直径大于10 cm）患者（平均年龄56岁；6例男性）在3家不同机构接受了腹腔镜下贲门肌切开术和前胃底折叠术。所有患者术前检查均包括上消化道内镜检查、食管造影和食管测压。平均随访31.5个月（范围3至60个月）。2例患者（18%）有严重吞咽困难，4例患者（36%）有轻度且偶尔的固体食物吞咽困难，5例患者（45%）无症状。除2例严重吞咽困难患者外，所有患者体重均增加或保持不变。2例严重吞咽困难患者中，1例接受了食管扩张术，另1例接受了腹腔镜食管切除术。他们目前情况良好。即使食管重度扩张，贲门肌切开术仍可缓解大多数患者的吞咽困难。
