Migaczewski Marcin, Zub-Pokrowiecka Anna, Grzesiak-Kuik Agata, Pędziwiatr Michał, Major Piotr, Rubinkiewicz Mateusz, Winiarski Marek, Natkaniec Michał, Budzyński Andrzej
Second Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
Wideochir Inne Tech Maloinwazyjne. 2015 Apr;10(1):10-4. doi: 10.5114/wiitm.2015.48571. Epub 2015 Jan 27.
The last two decades have observed development of surgical treatment of benign conditions of the gastroesophageal junction (GEJ), including anti-reflux surgery, due to the growing popularity of the laparoscopic approach. Migration of the fundoplication band and recurrent hiatal hernia are a result of the lack of correct diagnosis and appropriate management of the so-called short esophagus. According to various authors, short esophagus is present in up to 60% of patients qualified for anti-reflux surgery. However, some researchers question the existence of this condition.
To analyze the prevalence of short esophagus in patients subjected to laparoscopic Nissen fundoplication.
The study included 202 patients who were subjected to laparoscopic Nissen fundoplication.
As many as 96% of the patients qualified for the surgical treatment showed supradiaphragmatic location of the high pressure zone. The extent of GEJ protrusion ranged from 0 cm to 3 cm (mean: 2 cm). The extent of dissection within the mediastinum was determined by the level of GEJ protrusion, and ranged from 5 cm to 12 cm (mean: 6 cm). Upon complete mobilization of the esophagus within the mediastinum, no cases of significantly shortened esophagus, precluding downward retraction of at least a 2.5-cm segment below the diaphragmatic crura, were documented. Therefore, none of the patients required Collis gastroplasty.
The presence of "true" short esophagus is a sporadic finding among patients qualified for anti-reflux surgery. Mediastinal dissection of the esophagus and its mobilization at an appropriate, individually defined level seems a sufficient treatment in the vast majority of these patients.
在过去二十年中，随着腹腔镜手术方法越来越受欢迎，胃食管交界（GEJ）良性疾病的外科治疗得到了发展，包括抗反流手术。胃底折叠带移位和复发性食管裂孔疝是所谓短食管诊断不正确和处理不当的结果。根据不同作者的观点，高达60%符合抗反流手术条件的患者存在短食管。然而，一些研究人员对这种情况的存在提出质疑。
分析接受腹腔镜Nissen胃底折叠术患者中短食管的患病率。
该研究纳入了202例接受腹腔镜Nissen胃底折叠术的患者。
多达96%符合手术治疗条件的患者高压区位于膈上。GEJ突出程度为0厘米至3厘米（平均：2厘米）。纵隔内的游离范围由GEJ突出水平决定，范围为5厘米至12厘米（平均：6厘米）。在纵隔内完全游离食管后，未记录到食管明显缩短以至于无法将至少2.5厘米长的一段食管向下牵拉至膈脚下方的病例。因此，没有患者需要进行科利斯胃成形术。
“真正的”短食管在符合抗反流手术条件的患者中是一个散发性发现。对食管进行纵隔游离并在适当的、个体化确定的水平进行松解，在绝大多数此类患者中似乎是一种充分的治疗方法。
