Andolfi Ciro, Kavitt Robert T, Herbella Fernando A M, Patti Marco G
1 Department of Surgery and Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine , Chicago, Illinois.
2 Department of Gastroenterology, University of Chicago Pritzker School of Medicine , Chicago, Illinois.
J Laparoendosc Adv Surg Tech A. 2016 Sep;26(9):675-9. doi: 10.1089/lap.2016.0246. Epub 2016 Jun 10.
Dysphagia and regurgitation are considered typical symptoms of achalasia. However, there is mounting evidence that some achalasia patients may also experience respiratory symptoms such as cough, wheezing, and hoarseness.
The aims of this study were to determine: (1) what percentage of achalasia patients experience respiratory symptoms and (2) the effect of a laparoscopic Heller myotomy and Dor fundoplication on the typical and respiratory symptoms of achalasia.
Between May 2008 and December 2015, 165 patients with achalasia were referred for treatment to the Center for Esophageal Diseases of the University of Chicago. Patients had preoperatively a barium swallow, endoscopy, and esophageal manometry. All patients underwent a Heller myotomy and Dor fundoplication.
Based on the presence of respiratory symptoms, patients were divided into two groups: group A, 98 patients (59%) without respiratory symptoms and group B, 67 patients (41%) with respiratory symptoms. The preoperative Eckardt score was similar in the two groups (6.5 ± 2.1 versus 6.4 ± 2.0). The mean esophageal diameter was 27.7 ± 10.8 mm in group A and 42.6 ± 20.1 mm in group B (P < .05). The operation consisted of a myotomy that extended for 5 cm on the esophagus and 2.5 cm onto the gastric wall. At a median postoperative follow-up of 17 months, the Eckardt score improved significantly and similarly in the two groups (0.3 ± 0.8 versus 0.3 ± 1.0). Respiratory symptoms improved or resolved in 62 patients (92.5%).
The results of this study showed that: (1) respiratory symptoms were present in 41% of patients; (2) patients with respiratory symptoms had a more dilated esophagus; and (3) surgical treatment resolved or improved respiratory symptoms in 92.5% of patients. This study underlines the importance of investigating the presence of respiratory symptoms along with the more common symptoms of achalasia and of early treatment before lung damage occurs.
吞咽困难和反流被认为是贲门失弛缓症的典型症状。然而，越来越多的证据表明，一些贲门失弛缓症患者也可能出现咳嗽、喘息和声音嘶哑等呼吸道症状。
本研究的目的是确定：（1）贲门失弛缓症患者出现呼吸道症状的百分比；（2）腹腔镜下Heller肌切开术和Dor胃底折叠术对贲门失弛缓症典型症状和呼吸道症状的影响。
2008年5月至2015年12月期间，165例贲门失弛缓症患者被转诊至芝加哥大学食管疾病中心接受治疗。患者术前进行了钡餐造影、内镜检查和食管测压。所有患者均接受了Heller肌切开术和Dor胃底折叠术。
根据呼吸道症状的有无，患者分为两组：A组，98例（59%）无呼吸道症状；B组，67例（41%）有呼吸道症状。两组术前Eckardt评分相似（6.5±2.1对6.4±2.0）。A组平均食管直径为27.7±10.8mm，B组为42.6±20.1mm（P<0.05）。手术包括在食管上延伸5cm和在胃壁上延伸2.5cm的肌切开术。术后中位随访17个月时，两组Eckardt评分均显著且相似地改善（0.3±0.8对0.3±1.0）。62例患者（92.5%）的呼吸道症状得到改善或缓解。
本研究结果表明：（1）41%的患者存在呼吸道症状；（2）有呼吸道症状的患者食管扩张更明显；（3）手术治疗使92.5%的患者呼吸道症状得到缓解或改善。本研究强调了在贲门失弛缓症常见症状的基础上调查呼吸道症状的存在以及在肺部损伤发生前进行早期治疗的重要性。
