经腹腔镜经裂孔手术治疗源自风箱样食管的膈上食管憩室：一例报告

Laparoscopic transhiatal surgery for an epiphrenic esophageal diverticulum derived from a jackhammer esophagus: a case report.

作者信息

Fujinaga Atsuro, Shibata Tomotaka, Etoh Tsuyoshi, Tada Kazuhiro, Suzuki Kosuke, Nishiki Kohei, Ogawa Katsuhiro, Kono Yohei, Hiratsuka Takahiro, Akagi Tomonori, Ueda Yoshitake, Toujigamori Manabu, Shiroshita Hidefumi, Shiraishi Norio, Inomata Masafumi

机构信息

Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Oita, 879-5593, Japan.

Department of Gastroenterological Surgery, Oita Nakamura Hospital, Oita, Japan.

出版信息

Surg Case Rep. 2020 Jun 29;6(1):151. doi: 10.1186/s40792-020-00900-2.

DOI:10.1186/s40792-020-00900-2

PMID:32601779

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7324458/

Abstract

BACKGROUND

An esophageal diverticulum is rare and is frequently associated with esophageal motility disorders. Jackhammer esophagus is also rare, is characterized by esophageal hypercontraction, and comprises 4.1% of esophageal motility disorders. Here, we report a case of a patient successfully treated by laparoscopic transhiatal surgery for an epiphrenic esophageal diverticulum derived from a jackhammer esophagus diagnosed with high-resolution manometry (HRM).

CASE PRESENTATION

The patient was a 78-year-old man who presented to the hospital with dysphagia. A diverticulum was detected in the lower part of his esophagus by upper gastrointestinal endoscopy. HRM was performed to investigate esophageal motility disorders. His integrated relaxation pressure was normal at 25.9 (< 26) mmHg, but his distal contractile integral (DCI) was very high at 21,464 (1500-13,000) mmHg s cm. Esophageal peristalsis was preserved. Therefore, the patient was diagnosed as having an epiphrenic esophageal diverticulum derived from a jackhammer esophagus for which laparoscopic transhiatal diverticulectomy and Heller-Dor procedure were performed. The postoperative course was uneventful. His symptoms improved, and the level of DCI also returned to a normal level of 3867 mmHg s cm at 2 months after the operation.

CONCLUSION

Laparoscopic transhiatal diverticulectomy and esophagomyotomy can be useful procedures for an epiphrenic esophageal diverticulum derived from a jackhammer esophagus due to their lower invasiveness.

摘要

背景

食管憩室较为罕见，常与食管动力障碍相关。强力型食管也很罕见，其特征为食管过度收缩，占食管动力障碍的4.1%。在此，我们报告一例通过腹腔镜经裂孔手术成功治疗的病例，该患者为源自强力型食管的膈上食管憩室，通过高分辨率测压法（HRM）确诊。

病例介绍

患者为一名78岁男性，因吞咽困难入院。上消化道内镜检查在其食管下段发现一个憩室。进行HRM以研究食管动力障碍。他的综合松弛压正常，为25.9（<26）mmHg，但他的远端收缩积分（DCI）非常高，为21464（1500 - 13000）mmHg·s·cm。食管蠕动保留。因此，该患者被诊断为源自强力型食管的膈上食管憩室，并接受了腹腔镜经裂孔憩室切除术和Heller - Dor手术。术后病程顺利。他的症状改善，术后2个月时DCI水平也恢复到正常水平3867 mmHg·s·cm。