Cuschieri A
Dept. of Surgery, Ninewells Hospital & Medical School, University of Dundee, Scotland.
Endosc Surg Allied Technol. 1993 Oct-Dec;1(5-6):280-7.
The management of oesophageal motility disorders has been unsatisfactory due to the lack of effective pharmacological treatment. Endoscopic surgical myotomy offers an effective long-term therapy without the disadvantages of a thoracotomy. After characterization by oesophageal manometry 12 patients with achalasia and 23 patients with non-cardiac chest pain were considered suitable for myotomy. For achalasia, the laparoscopic approach was preferred to the thoracoscopic route. Fundoplication was not performed unless a hiatus hernia was present or as a buttress protection following suture of an iatrogenic perforation of the oesophageal mucosa. For patients with non-cardiac chest pain a thoracoscopic long myotomy was performed from the left side with the patient operated on in the postero-lateral position. Three perforations (all sutured endoscopically) were encountered: two during cardiomyotomy, one during long myotomy. Complete or substantial relief of chest pain was encountered in 18 patients, with five patients having no relief of their pain. Our experience indicates that long myotomy is successful but longer term follow-up is required to assess its therapeutic role.
由于缺乏有效的药物治疗，食管动力障碍的管理一直不尽人意。内镜手术肌切开术提供了一种有效的长期治疗方法，且没有开胸手术的缺点。在通过食管测压进行特征性评估后，12例贲门失弛缓症患者和23例非心源性胸痛患者被认为适合进行肌切开术。对于贲门失弛缓症，腹腔镜手术途径优于胸腔镜途径。除非存在食管裂孔疝，或者在缝合食管黏膜医源性穿孔后作为支撑保护，否则不进行胃底折叠术。对于非心源性胸痛患者，在患者处于后外侧位时从左侧进行胸腔镜下长肌切开术。遇到3处穿孔（均在内镜下缝合）：2处在贲门肌切开术中，1处在长肌切开术中。18例患者胸痛完全或明显缓解，5例患者疼痛未缓解。我们的经验表明，长肌切开术是成功的，但需要更长时间的随访来评估其治疗作用。
