Parrilla Paricio P, Martinez de Haro L F, Ortiz Escandell A, Morales Cuenca G, Molina Martinez J
Department of Surgery, University Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain.
Br J Surg. 1993 Dec;80(12):1540-2. doi: 10.1002/bjs.1800801215.
Vigorous achalasia has been considered an indication for surgery, in which a thoracic approach is recommended for extending the myotomy along the whole of the oesophageal body to the point where manometry shows high-amplitude waves. Clinical results and postoperative manometric findings in 16 patients with vigorous achalasia undergoing abdominal surgery with myotomy limited to the lower oesophageal sphincter (LOS) were analysed to assess whether extended myotomy is necessary in surgery for this form of achalasia. The clinical results were excellent or good in all cases. Surgery induced a significant decrease (P < 0.01) in the diameter of the oesophagus as determined radiologically. The most significant postoperative manometric changes were a decrease in the resting pressure of the LOS and oesophageal body, a lowering of wave amplitude at all levels of the oesophagus, and a reduction in the proportion of repetitive waves. The results suggest that vigorous achalasia can be treated surgically in the same way as classical achalasia and question, at least from a therapeutic viewpoint, the use of the term vigorous achalasia.
强力型贲门失弛缓症一直被视为手术指征，对于此类病症，推荐采用开胸手术，以便将肌切开术沿食管体全长延伸至测压显示高振幅波的部位。分析了16例接受腹部手术且肌切开术仅限于食管下括约肌（LOS）的强力型贲门失弛缓症患者的临床结果和术后测压结果，以评估对于这种贲门失弛缓症形式的手术是否有必要进行扩大肌切开术。所有病例的临床结果均为优或良。手术导致经放射学测定的食管直径显著减小（P < 0.01）。术后最显著的测压变化是食管下括约肌和食管体静息压力降低、食管各水平波幅降低以及重复波比例减少。结果表明，强力型贲门失弛缓症可采用与经典贲门失弛缓症相同的手术方式进行治疗，并且至少从治疗角度对“强力型贲门失弛缓症”这一术语的使用提出了质疑。
