Pricolo V E, Park C S, Thompson W R
Department of Surgery, Rhode Island Hospital, Providence 02903.
Arch Surg. 1993 May;128(5):540-3; discussion 543-4. doi: 10.1001/archsurg.1993.01420170074010.
Esophageal perforation is a rare complication of pneumatic dilatation for achalasia. The few clinical series reported in the literature recommend, under most circumstances, esophageal repair combined with esophagocardiomyotomy. However, the superiority of this technique over repair alone has never been proven. We reviewed our experience, since 1979, with six operative cases of esophageal perforation from pneumatic dilatation for achalasia. After débridement, the esophagus was repaired and, if possible, buttressed with a gastric fundal patch. There was only one late postoperative death due to sepsis and one upper gastrointestinal bleeding complication in our series. Follow-up (1 to 12 years) revealed no dysphagia in any of the five surviving patients and mild gastroesophageal reflux in two. From a review of the literature we found no reports of similarly treated patients experiencing recurrent symptoms of achalasia. In these acutely ill patients, our operative strategy is more feasible than repair and esophagocardiomyotomy and equally effective.
食管穿孔是贲门失弛缓症气囊扩张术罕见的并发症。文献中报道的少数临床系列研究在大多数情况下推荐食管修复联合食管贲门肌层切开术。然而，该技术相对于单纯修复的优越性从未得到证实。我们回顾了自1979年以来因贲门失弛缓症气囊扩张导致食管穿孔的6例手术病例的经验。清创后，修复食管，如有可能，用胃底补片加固。我们的系列研究中仅有1例因败血症导致术后晚期死亡和1例上消化道出血并发症。随访（1至12年）发现，5例存活患者均无吞咽困难，2例有轻度胃食管反流。通过文献回顾，我们未发现类似治疗的患者出现贲门失弛缓症复发症状的报道。在这些重症患者中，我们的手术策略比修复及食管贲门肌层切开术更可行且同样有效。
