Donahue P E, Schlesinger P K, Sluss K F, Richter H M, Liu K J, Rypins E B, Nyhus L M
Department of Surgery, Cook County Hospital, Chicago, IL 60612.
Surgery. 1994 Oct;116(4):719-24; discussion 724-5.
Effective surgical treatments for achalasia of the esophagus facilitate swallowing by division of muscles that fail to relax normally during swallowing. If esophagocardiomyotomy is performed, a complementary antireflux procedure is mandatory to prevent postoperative gastroesophageal reflux. We evaluated patients who had undergone a circumferential antireflux procedure after esophagocardiomyotomy to determine the effects of this procedure in patients with an aperistaltic esophagus.
During the past 15 years we treated 94 patients with achalasia by use of pneumatic dilation (66), esophageal myotomy (19), or esophagocardiomyotomy with floppy Nissen fundoplication (24). Achalasia was defined by radiographic and manometric criteria until 1986 when computerized axial manometry of the esophagus was initiated, providing information about the three-dimensional contour and "volume" of the lower esophageal sphincter in addition to the usual manometric data.
Dysphagia was effectively relieved in all, and neither postoperative reflux nor esophageal obstruction was observed after esophagocardiomyotomy followed by floppy Nissen fundoplication. The measured lower esophageal sphincter pressures and sphincter volume were markedly reduced.
Esophagocardiomyotomy with floppy Nissen fundoplication is an effective treatment for achalasia; clinical evidence of obstruction of the esophagus was not seen, and manometric data were typical of a weakened sphincter.
有效的食管贲门失弛缓症手术治疗通过切断吞咽时不能正常松弛的肌肉来促进吞咽。如果进行食管贲门肌层切开术，必须进行补充抗反流手术以防止术后胃食管反流。我们评估了在食管贲门肌层切开术后接受环周抗反流手术的患者，以确定该手术对无蠕动食管患者的效果。
在过去15年中，我们使用气囊扩张术（66例）、食管肌层切开术（19例）或食管贲门肌层切开术加软性尼森胃底折叠术（24例）治疗了94例贲门失弛缓症患者。在1986年开始进行食管计算机轴向测压之前，贲门失弛缓症是根据放射学和测压标准定义的，该技术除了提供常规测压数据外，还能提供有关食管下括约肌三维轮廓和“容积”的信息。
所有患者的吞咽困难均得到有效缓解，食管贲门肌层切开术加软性尼森胃底折叠术后未观察到术后反流或食管梗阻。测得的食管下括约肌压力和括约肌容积明显降低。
食管贲门肌层切开术加软性尼森胃底折叠术是治疗贲门失弛缓症的有效方法；未见到食管梗阻的临床证据，测压数据显示括约肌功能减弱。
