Soulier Y, Lefort J, Borde J, Valayer J
Chir Pediatr. 1979;20(5):311-6.
The authors undertook a retrospective study of a series of 17 cases of idiopathic megaoesophagus seen over a period of 25 years in two paediatric surgery departments. Age distribution was regularly between 20 months and 15 years. No neonatal nor familial forms were seen. Symptoms were dominated by regurgitation and dysphagia. Weight loss was an almost constant feature. Heller's operation, via an abdominal approach with retro-oesophageal valve of the tuberosity fixed to both edges of the myotomy, was the operation proposed. In one case of recurrent megaoesophagus operated upon elsewhere a Thal operation gave a good result with a follow up of 8 years. Immediate clinical and radiological results were favourable in the great majority of cases : 16 cases out of 17. Long term results (follow up of more than 5 years in 8 patients) were also favourable. However one patient was sometimes troubled by regurgitations due to persistent achalasia and a grave failure occured in a patient who five years after a Heller operation developed a peptic stenosis of the lower oesophagus. No recurrence of megaoesophagus was seen. The authors emphasise the importance of the prevention of gastro-oesophageal reflux and the value of oesophagoscopy and of manometry in cases where the result of a Heller's operation is imperfect.
作者对两个儿科外科在25年间收治的17例特发性巨食管病例进行了回顾性研究。年龄分布通常在20个月至15岁之间。未发现新生儿型和家族型病例。症状以反流和吞咽困难为主。体重减轻几乎是一个持续存在的特征。建议采用经腹入路的赫勒氏手术，将结节的食管后瓣膜固定在肌切开术的两侧边缘。在1例曾在其他地方接受过手术的复发性巨食管病例中，塔尔手术取得了良好效果，随访8年。绝大多数病例（17例中的16例）的即时临床和放射学结果良好。长期结果（8例患者随访超过5年）也很理想。然而，1例患者因持续性贲门失弛缓症有时会出现反流问题，1例患者在赫勒氏手术后5年出现了食管下段消化性狭窄，导致严重失败。未发现巨食管复发。作者强调了预防胃食管反流的重要性，以及在赫勒氏手术效果不理想的情况下食管镜检查和测压的价值。
