Ellis F H
Division of Cardiothoracic Surgery, New England Deaconess Hosital, Harvard Medical School, Boston, Massachusetts.
Br J Surg. 1993 Jul;80(7):882-5. doi: 10.1002/bjs.1800800727.
To determine the clinical results in achalasia, particularly as regards postoperative gastro-oesophageal reflux, a 22-year personal experience with transthoracic short oesophagomyotomy without an antireflux procedure was analysed. A total of 185 such procedures were performed, of which 179 (97 per cent) were available for analysis. There was an overall improvement rate of 89 per cent over a mean postoperative interval of 9 years. Primary procedures were followed by a 93 per cent rate of improvement. Twenty patients, nine of whom had previously undergone one or more oesophageal operations, were considered as having a poor result. Marked gastro-oesophageal reflux accounted for a poor outcome in nine patients. Although the overall rate of postoperative improvement did not deteriorate significantly with time, the level of improvement did, the proportion of excellent results declining from 54 to 32 per cent (P = 0.02) at 10-20 years after operation. These findings substantiate the view that a short transthoracic oesophagomyotomy without an antireflux procedure provides excellent long-term relief of dysphagia for the patient with oesophageal achalasia and is accompanied by an extremely low risk of serious postoperative gastro-oesophageal reflux.
为了确定贲门失弛缓症的临床治疗效果，尤其是术后胃食管反流方面的效果，对经胸短食管肌层切开术（未行抗反流手术）22年的个人经验进行了分析。共进行了185例此类手术，其中179例（97%）可供分析。术后平均9年的总体改善率为89%。初次手术的改善率为93%。20例患者被认为治疗效果不佳，其中9例此前曾接受过一次或多次食管手术。明显的胃食管反流导致9例患者预后不良。虽然术后总体改善率并未随时间显著恶化，但改善程度有所下降，术后10 - 20年时，优秀结果的比例从54%降至32%（P = 0.02）。这些发现证实了这样一种观点，即经胸短食管肌层切开术（未行抗反流手术）能为食管贲门失弛缓症患者提供出色的长期吞咽困难缓解效果，且术后严重胃食管反流的风险极低。
