Patti M G, Pellegrini C A
Department of Surgery, University of California, San Francisco, USA.
J R Coll Surg Edinb. 1996 Jun;41(3):137-42.
Achalasia, nutcracker oesophagus and diffuse oesophageal spasm are primary oesophageal motility disorders whose treatment has been substantially impacted by the advent and development of minimally invasive surgery. Although several studies had shown that oesophageal myotomy was effective in the treatment of several of these disorders, particularly in the more advanced stages, many of the patients who could have benefited from an operation were instead with medications or balloon dilation, sometimes despite repeated failures of this form of therapy. To a certain extent, this reflected patient and physicians' concerns with the post-operative discomfort and the long recovery time inevitably associated with the performance of a thoracotomy or laparotomy. Today, however, we and others have shown that minimally invasive techniques allow an operation to be performed with the same excellent results provided by open surgery, but with a shorter hospital stay, minimal post-operative discomfort, and faster return to work. We performed our first thoracoscopic myotomy for achalasia in January of 1991, initially using a technique developed by Dr. Cuschieri, which we modified as we gained experience. Subsequently, we extended the same technique to the treatment of diffuse oesophageal spasm and nutcracker oesophagus. This report describes our experience at the University of California at San Francisco and the University of Washington in Seattle for the diagnostic and therapeutic approach to patients with primary oesophageal motility disorders.
贲门失弛缓症、胡桃夹食管和弥漫性食管痉挛是原发性食管动力障碍，微创手术的出现和发展对其治疗产生了重大影响。尽管多项研究表明食管肌层切开术对其中几种疾病有效，尤其是在疾病较晚期时，但许多本可从手术中获益的患者却选择了药物治疗或球囊扩张，有时即便这种治疗方式反复失败仍如此。在一定程度上，这反映了患者和医生对开胸手术或剖腹手术后不适以及不可避免的较长恢复时间的担忧。然而如今，我们和其他研究者已表明，微创技术能实现与开放手术同样出色的手术效果，但住院时间更短、术后不适轻微且能更快重返工作岗位。1991年1月，我们首次为贲门失弛缓症患者实施了胸腔镜下肌层切开术，最初采用的是库希耶里医生研发的技术，并在积累经验的过程中对其进行了改良。随后，我们将同样的技术扩展应用于弥漫性食管痉挛和胡桃夹食管的治疗。本报告介绍了我们在加利福尼亚大学旧金山分校和华盛顿大学西雅图分校对原发性食管动力障碍患者的诊断和治疗方法的经验。
