Slater G, Sicular A A
Ann Surg. 1982 Feb;195(2):186-8. doi: 10.1097/00000658-198202000-00011.
The reported incidence of esophageal perforation after forceful dilatation in achalasia is between 1-5%. Over the past nine years we have treated five patients with this complication. After demonstrating the perforation with a Gastrografin swallow, a left posterolateral thoracotomy is made. The full-thickness laceration is sutured in two layers. A Heller esophagocardiomyotomy is then performed on the contralateral side of the esophagus. The muscular layer on either side of the esophagocardiomyotomy is mobilized well so as to allow easy closure of the outer muscular layer of the esophagus in the area of the laceration. There were no deaths and minimal morbidity in these five patients, and functional results were excellent. It is concluded that perforations of the esophagus after dilatation in achalasia should be operated on promptly and undergo closure of the laceration with a complimentary esophagocardiomyotomy.
贲门失弛缓症强力扩张术后食管穿孔的报道发生率在1%至5%之间。在过去九年里，我们治疗了五例出现这种并发症的患者。通过吞咽泛影葡胺证实穿孔后，行左后外侧开胸术。全层撕裂伤分两层缝合。然后在食管对侧进行赫勒食管贲门肌层切开术。食管贲门肌层切开术两侧的肌层充分游离，以便在撕裂伤区域轻松关闭食管外层肌层。这五例患者均无死亡，发病率极低，功能结果极佳。结论是，贲门失弛缓症扩张术后的食管穿孔应及时手术，并通过补充性食管贲门肌层切开术关闭撕裂伤。
