Benacci J C, Deschamps C, Trastek V F, Allen M S, Daly R C, Pairolero P C
Section of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota 55905.
Ann Thorac Surg. 1993 May;55(5):1109-13; discussion 1114. doi: 10.1016/0003-4975(93)90016-b.
From 1975 to 1991, 112 patients (64 men and 48 women) were found to have an epiphrenic diverticulum. Symptoms were absent or minimal in 71 patients and incapacitating in 41. All patients with minimal symptoms were managed conservatively; 35 were available for follow-up, which ranged from 1 to 25 years (median, 9 years). None of these 35 patients had clinically significant progression of symptoms. Surgical repair was done in 33 patients with incapacitating symptoms. Achalasia was present in 8 of the surgical patients (24.2%), diffuse esophageal spasm in 3 (9.1%), hypertensive lower esophageal sphincter alone in 1 (3.0%), and nonspecific motor abnormalities of the esophageal body in 7 (21.2%). Diverticulectomy and esophagomyotomy were performed in 22 patients, diverticulectomy alone in 7, esophageal resection in 3, and esophagomyotomy alone in 1. Concomitant hiatal hernia repair was done in 6 patients. Complications occurred in 11 patients; 6 had esophageal leaks. There were three operative deaths (9.1%), all occurring in patients with abnormal manometry. Follow-up was complete in 29 patients and ranged from 4 months to 15 years (median, 6.9 years). Long-term results were excellent in 14 patients (48.2%), good in 8 (27.6%), fair in 5 (17.2%), and poor in 2 (6.9%). We conclude that operation has significant risks and is not warranted in patients with minimal symptoms because progression is unlikely. Surgical treatment, however, is advisable in patients with incapacitating symptoms because most operative survivors will have long-term symptomatic palliation.
1975年至1991年期间，发现112例患者（64例男性和48例女性）患有膈上憩室。71例患者无症状或症状轻微，41例患者症状严重，影响日常生活。所有症状轻微的患者均采用保守治疗；35例患者接受了随访，随访时间为1至25年（中位数为9年）。这35例患者中无一例症状出现具有临床意义的进展。33例症状严重、影响日常生活的患者接受了手术修复。手术患者中有8例（24.2%）患有贲门失弛缓症，3例（9.1%）患有弥漫性食管痉挛，1例（3.0%）仅有高血压性下食管括约肌，7例（21.2%）患有食管体部非特异性运动异常。22例患者行憩室切除术和食管肌层切开术，7例仅行憩室切除术，3例行食管切除术，1例仅行食管肌层切开术。6例患者同时行食管裂孔疝修补术。11例患者出现并发症；6例发生食管漏。有3例手术死亡（9.1%），均发生在测压异常的患者中。29例患者完成随访，随访时间为4个月至15年（中位数为6.9年）。14例患者（48.2%）长期效果极佳，8例（27.6%）良好，5例（17.2%）尚可，2例（6.9%）较差。我们得出结论，手术有重大风险，对于症状轻微的患者不值得进行，因为症状进展的可能性不大。然而，对于症状严重、影响日常生活的患者，手术治疗是可取的，因为大多数手术存活者将获得长期的症状缓解。
