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[食管动力障碍的微创手术]

[Minimally invasive surgery for motility disorders of the oesophagus].

作者信息

Andrási László, Ábrahám Szabolcs, Simonka Zsolt, Paszt Attila, Erdős Márton, Rovó László, Rosztóczy András, Ollé Georgina, Lázár György

机构信息

1 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország (tanszékvezető: Prof. Dr. Lázár György).

2 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika, Szeged, Magyarország (tanszékvezető: Prof. Dr. Rovó László).

出版信息

Magy Seb. 2022 Jun 20;75(2):121-132. doi: 10.1556/1046.2022.20006.

Abstract

Introduction and aims. We present our experience with minimally invasive surgery for pharyngoesophageal (Zenker) diverticulums, epiphrenic diverticulums and achalasia cardiae focusing on the perioperative features and patients’ quality of life. Patients and methods. Between 1 January 2003 and 31 December 2020, patients were selected with a symptom-causing Zenker diverticulum, epiphrenic diverticulum and achalasia cardiae. In 17 cases, transoral stapler diverticulostomy, in 23 cases transcervical diverticulectomy and cricomyotomy were done because of Zenker diverticulum, in 14 cases, laparoscopic transhiatal surgery was performed because of epiphrenic diverticula, while in 63 cases, laparoscopic Heller–Dor operation were carried out because of achalasia cardiae. Perioperative results, the quality of life outcomes of various surgeries were evaluated in mid- and long-term. Results/conclusions. The surgeries were performed with minimal blood loss, zero mortality and low morbidity. According to our result, the two different surgical approaches in the therapy of Zenker’s diverticulum, the laparoscopic Heller–Dor procedure applied in the management of epiphrenic diverticulas and achalasia cardiae are safe and effective operations. In the long term, the symptom control in patients after minimally invasive surgeries is sufficient and only a small percentage of the patients may require additional medication therapy and/or reintervention due to persistent complaints.

摘要

引言与目的。我们介绍了我们在针对咽食管(Zenker)憩室、膈上憩室和贲门失弛缓症的微创手术方面的经验,重点关注围手术期特征和患者的生活质量。患者与方法。在2003年1月1日至2020年12月31日期间,选择患有引起症状的Zenker憩室、膈上憩室和贲门失弛缓症的患者。因Zenker憩室,17例行经口吻合器憩室造口术,23例行经颈憩室切除术及环甲膜切开术;因膈上憩室,14例行腹腔镜经裂孔手术;因贲门失弛缓症,63例行腹腔镜Heller - Dor手术。对围手术期结果、各种手术的生活质量结局进行了中长期评估。结果/结论。手术出血量极少,死亡率为零,发病率低。根据我们的结果,治疗Zenker憩室的两种不同手术方法、用于治疗膈上憩室和贲门失弛缓症的腹腔镜Heller - Dor手术是安全有效的手术。从长期来看,微创手术后患者的症状控制充分,只有一小部分患者可能因持续不适而需要额外的药物治疗和/或再次干预。

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