Miller D L, Allen M S, Trastek V F, Deschamps C, Pairolero P C
Section of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Ann Thorac Surg. 1995 Oct;60(4):922-5; discussion 925-6. doi: 10.1016/0003-4975(95)00522-m.
This study examined esophageal resection as treatment for recurrence or treatment complications of achalasia.
From 1976 through 1992, 37 patients (20 men and 17 women) underwent esophageal resection after initial surgical treatment for achalasia. The median age was 56 years (range, 19 to 84 years). Initial surgical treatment consisted of modified Heller myotomy in 28 patients, combined myotomy and antireflux procedure in 6, and antireflux procedure alone in 3. Twenty-six patients required an additional surgical procedure before esophageal resection (70.3%). Indication for esophageal resection was obstructive symptoms in 30 patients, cancer in 3, bleeding in 2, and perforation during dilation in 2. Reconstruction was established with the stomach in 26 patients, colon in 6, and small bowel in 5. Anastomosis was at the cervical level in 20 patients (54.1%) and intrathoracic in 17 (45.9%).
There were two operative deaths (5.4%), both caused by intraoperative hemorrhage during transhiatal resection. Twelve patients (32.4%) had complications, which included cardiac dysrhythmia in 3, cervical anastomotic leak in 2, transient vocal cord paralysis in 2, pneumonia in 2, pulmonary embolus in 2, and reexploration for bleeding in 1. Follow-up was complete in all patients and ranged from 1.4 to 16 years (median, 6.3 years). Excellent or good long-term functional results were present in 32 patients (91.4%).
Esophageal resection provides reasonable long-term functional results in patients with recurrence or treatment complications of achalasia. In our experience, transhiatal resection is associated with increased morbidity and mortality.
本研究探讨了食管切除术作为贲门失弛缓症复发或治疗并发症的治疗方法。
1976年至1992年期间，37例患者（20例男性和17例女性）在初次手术治疗贲门失弛缓症后接受了食管切除术。中位年龄为56岁（范围19至84岁）。初次手术治疗包括28例患者行改良Heller肌切开术，6例患者行肌切开术联合抗反流手术，3例患者仅行抗反流手术。26例患者在食管切除术前需要再次手术（70.3%）。食管切除的指征为30例患者有梗阻症状，3例患者有癌症，2例患者有出血，2例患者在扩张时穿孔。26例患者用胃重建，6例患者用结肠重建，5例患者用小肠重建。20例患者（54.1%）的吻合口位于颈部，17例患者（45.9%）的吻合口位于胸内。
有2例手术死亡（5.4%），均因经裂孔切除术中出血所致。12例患者（32.4%）出现并发症，包括3例心脏心律失常、2例颈部吻合口漏、2例短暂性声带麻痹、2例肺炎、2例肺栓塞和1例因出血再次探查。所有患者均完成随访，随访时间为1.4至16年（中位时间为6.3年）。32例患者（91.4%）获得了良好或优秀的长期功能结果。
食管切除术为贲门失弛缓症复发或治疗并发症患者提供了合理的长期功能结果。根据我们的经验，经裂孔切除术与发病率和死亡率增加相关。
