Tsuboi Kazuto, Omura Nobuo, Yano Fumiaki, Hoshino Masato, Yamamoto Se Ryung, Akimoto Shunsuke, Kashiwagi Hideyuki, Yanaga Katsuhiko
Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan,
Surg Today. 2015 Feb;45(2):253-7. doi: 10.1007/s00595-014-0884-6. Epub 2014 Mar 20.
We herein report our technique for laparoscopic esophageal myotomy combined with Collis gastroplasty and Nissen fundoplication for severe esophageal stenosis. Our patient had experienced vomiting since childhood, and his dysphagia had gradually worsened. He was referred to our department for surgery because of resistance to pneumatic dilation. He was diagnosed with a short esophagus based on the findings of a preoperative upper gastrointestinal series and GI endoscopy. After exposing the abdominal esophagus, esophageal myotomy around the esophago-gastric junction (EGJ) was undertaken to introduce an esophageal bougie into the stomach. Then, stapled wedge gastroplasty was performed, and a short and loose Nissen fundoplication was performed. In addition, the bulging mucosa after myotomy was patched using the Dor method. The patient's postoperative course was uneventful. Most patients with esophageal stricture require subtotal esophagectomy. Laparoscopic surgery for patients with benign esophageal stricture refractory to repeated pneumatic dilation is challenging. However, our current procedure might abrogate the need for invasive esophagectomy for the surgical management of severe esophageal stenosis.
我们在此报告我们采用腹腔镜食管肌层切开术联合科利斯胃成形术和nissen胃底折叠术治疗严重食管狭窄的技术。我们的患者自幼就有呕吐症状，吞咽困难逐渐加重。由于对气囊扩张术有抵抗，他被转诊至我们科室进行手术。根据术前上消化道造影和胃肠内镜检查结果，他被诊断为短食管。暴露腹部食管后，在食管胃交界处（EGJ）周围进行食管肌层切开术，将食管探条插入胃内。然后，进行吻合器楔形胃成形术，并进行短而宽松的nissen胃底折叠术。此外，采用Dor法修补肌层切开术后膨出的黏膜。患者术后恢复顺利。大多数食管狭窄患者需要行食管次全切除术。对于反复气囊扩张术无效的良性食管狭窄患者，腹腔镜手术具有挑战性。然而，我们目前的手术方法可能无需进行侵入性食管切除术来治疗严重食管狭窄。
