Ferguson M K, Reeder L B, Olak J
Department of Surgery, University of Chicago, Illinois, USA.
Ann Thorac Surg. 1996 Aug;62(2):327-30.
We questioned whether results of myotomy for achalasia are influenced by previous pneumatic dilation and whether surgical outcome is influenced by a dilation-related perforation necessitating urgent operation.
We performed a retrospective analysis of 60 patients who underwent transthoracic myotomy and fundoplication from 1977 to 1995. Dysphagia, heartburn, pain, and regurgitation were scored on a scale of 0 to 3 and results were classified according to combined symptom score.
Dilation was performed before myotomy once in 15 patients, twice in 25, 3 times or more in 9, and never in 11 patients. Operation was urgent due to perforation in 6 patients (10%). There was no postoperative leak or mortality. Overall symptom score at last follow-up (57 +/- 8 months; 90% of patients) was improved compared with preoperative score (2.1 +/- 0.3 months versus 5.1 +/- 0.2 months; p < 0.0001). Outcome was unrelated to whether or not a perforation occurred (excellent/good outcomes in 100% and 88%, respectively) or to whether or not preoperative dilations had been performed (excellent/good outcomes in 90% and 89%, respectively).
Myotomy and partial fundoplication is an effective technique for management of achalasia. Results are unaffected by the need for urgent operation for perforation and are unrelated to whether pneumatic dilation is performed preoperatively.
我们探讨了贲门失弛缓症肌切开术的结果是否受既往气囊扩张术的影响，以及手术结果是否受因扩张相关穿孔而需紧急手术的影响。
我们对1977年至1995年间接受经胸肌切开术和胃底折叠术的60例患者进行了回顾性分析。吞咽困难、烧心、疼痛和反流按0至3分进行评分，并根据综合症状评分对结果进行分类。
15例患者在肌切开术前进行了1次扩张，25例进行了2次扩张，9例进行了3次或更多次扩张，11例从未进行过扩张。6例患者（10%）因穿孔而进行了紧急手术。术后无渗漏或死亡病例。与术前评分相比，最后一次随访时（57±8个月；90%的患者）的总体症状评分有所改善（2.1±0.3个月对5.1±0.2个月；p<0.0001）。结果与是否发生穿孔（分别为100%和88%的优良结果）或术前是否进行扩张（分别为90%和89%的优良结果）无关。
肌切开术和部分胃底折叠术是治疗贲门失弛缓症的有效技术。结果不受因穿孔而需紧急手术的影响，且与术前是否进行气囊扩张无关。
