Vane D W, Cosby K, West K, Grosfeld J L
Department of Surgery, Indiana University Medical Center, Indianapolis.
J Pediatr Surg. 1988 Jun;23(6):515-9. doi: 10.1016/s0022-3468(88)80359-2.
Twenty one children with achalasia of the esophagus were treated from 1970 to 1986. There were 11 girls and ten boys (average age, 10.9 years; range, 6 months to 16 years). Diagnosis was established by barium swallow in 21 cases and confirmed by manometrics and motility studies in 14. Four children had unsuccessful dilatation (range, 1 to 16 dilatations/pt). All 21 children underwent modified anterior Heller esophagomyotomy (transabdominal in 15 and transthoracic in six). Concomitant Nissen fundoplication was performed in three. Follow-up from 1 to 14 years (mean, 6.3 years) showed complete relief of obstruction in 18 patients (86%), while three required additional procedures for persistent dysphagia. One child improved after a single dilatation, but two others eventually required a second esophagomyotomy. Three additional patients subsequently developed gastroesophageal reflux (GER), and two were managed with Nissen fundoplication; the third responded to medical management. The mortality for this series was zero. Postoperative complications occurred in nine children (42%) and was due to atelectasis and postoperative fever. Modified Heller esophagomyotomy is safe and effective in children with achalasia (mortality, 0%; relief of obstruction, 86%). Results were similar after a transabdominal or transthoracic approach. Esophageal dilatation was not an effective method of treatment. Although postsurgical barium swallow showed relief of obstruction, abnormal esophageal motility persisted, suggesting that long-term follow-up is important.
1970年至1986年期间，对21例食管失弛缓症患儿进行了治疗。其中女孩11例，男孩10例（平均年龄10.9岁；范围为6个月至16岁）。21例均通过吞钡检查确诊，14例经测压和动力研究得以证实。4例患儿扩张治疗失败（范围为1至16次扩张/患者）。所有21例患儿均接受了改良的前路赫勒食管肌层切开术（15例经腹，6例经胸）。3例同时进行了nissen胃底折叠术。随访1至14年（平均6.3年）显示，18例患者（86%）梗阻完全缓解，3例因持续性吞咽困难需要再次手术。1例患儿单次扩张后病情改善，但另外2例最终需要再次进行食管肌层切开术。另有3例患者随后出现胃食管反流（GER），2例接受了nissen胃底折叠术治疗；第3例经药物治疗有效。该系列的死亡率为零。9例患儿（42%）出现术后并发症，原因是肺不张和术后发热。改良赫勒食管肌层切开术治疗儿童食管失弛缓症安全有效（死亡率0%；梗阻缓解率86%）。经腹或经胸手术的结果相似。食管扩张不是一种有效的治疗方法。尽管术后吞钡检查显示梗阻缓解，但食管动力异常仍然存在，提示长期随访很重要。
