Peters J H, Kauer W K, Crookes P F, Ireland A P, Bremner C G, DeMeester T R
Department of Surgery, University of Southern California School of Medicine, Los Angeles, USA.
Arch Surg. 1995 Jun;130(6):632-6; discussion 636-7. doi: 10.1001/archsurg.1995.01430060070013.
To review the potential benefits of esophageal resection with colon interposition in patients with achalasia.
Retrospective review.
University-based tertiary care center.
Nineteen patients (13 men, six women; median age, 44 years; age range, 26 to 77 years) with achalasia and recurrent or persistent dysphagia despite a variety of previous treatments.
Esophageal resection and replacement with colon interposition.
Mortality and morbidity of the procedure, symptomatic outcome, nutritional impact, ability to ingest a meal, and overall patient satisfaction.
Follow-up results were available in 15 patients. The procedure accounted for no deaths and complications in four patients. Outcome assessment was done at a median of 6 years (range, 1 to 14 years) after resection. Overall, the symptomatic outcome was excellent to good in 12 patients. Eleven of the 15 patients gained weight (median weight loss, 6.3 kg) after the procedure. Thirteen patients were able to eat three meals daily; seven had the capacity to eat a steak dinner; five, an airline meal; and three, a snack. Nine of the 15 patients enjoyed an unrestricted diet. The speed of ingesting a meal was reduced in that most (11 of 15) were the last to finish when eating in a group. Fourteen of the 15 believed that the operation had cured or improved their preoperative symptoms, and a similar percentage were satisfied with the overall outcome of surgery. Most patients (12 of 15) would have the operation again.
Esophageal replacement for end-stage achalasia can be accomplished with safety and marked improvement of preoperative symptoms. Despite multiple previous therapeutic failures, normal alimentation was restored in the majority of patients, with 93% judging the operation to be highly beneficial, improving their quality of life. Based on this success, guidelines for resection in end-stage achalasia are established.
回顾采用结肠代食管术治疗贲门失弛缓症患者的潜在益处。
回顾性研究。
大学附属三级医疗中心。
19例贲门失弛缓症患者（13例男性，6例女性；年龄中位数44岁；年龄范围26至77岁），尽管此前接受了多种治疗，但仍有复发性或持续性吞咽困难。
食管切除术及结肠代食管术。
手术的死亡率和发病率、症状改善情况、营养影响、进食能力及患者总体满意度。
15例患者有随访结果。该手术无死亡病例，4例患者无并发症。在切除术后中位数6年（范围1至14年）进行结局评估。总体而言，12例患者的症状改善情况为优或良。15例患者中有11例术后体重增加（体重减轻中位数为6.3千克）。13例患者能够每日进食三餐；7例有能力吃牛排晚餐；5例能吃航空餐；3例能吃零食。15例患者中有9例饮食不受限制。多数患者（15例中的11例）在集体用餐时是最后吃完的，进食速度减慢。15例患者中有14例认为手术治愈或改善了术前症状，对手术总体结局满意的比例相似。多数患者（15例中的12例）愿意再次接受该手术。
终末期贲门失弛缓症的食管置换术可安全实施，且能显著改善术前症状。尽管此前多次治疗失败，但大多数患者恢复了正常营养，93%的患者认为手术非常有益，改善了他们的生活质量。基于这一成功经验，制定了终末期贲门失弛缓症的手术切除指南。
