de la Garza Villaseñor L, Cortés González R
Instituto Nacional de la Nutrición Salvador Zubirán, México, D.F.
Rev Gastroenterol Mex. 1996 Oct-Dec;61(4):320-6.
The different surgical approaches of Zenker's diverticulum are controversial.
To analyze the results of the surgical management of Zenker's diverticulum.
The charts of patients with surgical treatment of Zenker's diverticulum were reviewed in a retrospective fashion. The demographic and clinical data, surgical indication and procedures, operative morbidity and mortality and results were analyzed.
There were 15 patients, 12 men and 3 women with an average age of 68 years. All of them reported cervical dysphagia, 93 per cent regurgitation and 60 per cent upper airway symptoms. The barium esophageal study was diagnostic in all patients. Cricopharyngeal myotomy was performed in all patients and diverticulopexy (60 per cent) or diverticulectomy (40 per cent) was accomplished. There were one mucosal perforation during the myotomy but three esophageal fistula were developed during the first postoperative week. All three received medical treatment with healing between the 7th to 21st postoperative day. One patient suffered acute myocardial infarction and there were no deaths. During the follow-up in 14 patients (93.3 per cent) disappearance of symptoms were reported, in the remaining patient minimal dysphagia was present.
The surgical treatment of Zenker's diverticulum should be performed in symptomatic patients. The esophageal X-ray study is the best diagnostic tool. The cricopharyngeal myotomy is the keystone in the surgical treatment and may be complete with inversion, diverticulectomy or diverticulopexy according with the physical and clinical characteristics of diverticulum and the patient. There were excellent results in more than 90 per cent of the operated patients, with a low morbidity and no mortality.
针对Zenker憩室的不同手术方法存在争议。
分析Zenker憩室手术治疗的结果。
以回顾性方式查阅接受Zenker憩室手术治疗患者的病历。分析人口统计学和临床数据、手术指征及手术方式、手术发病率和死亡率以及结果。
共15例患者，男性12例，女性3例，平均年龄68岁。所有患者均有颈部吞咽困难，93%有反流，60%有上呼吸道症状。所有患者的钡剂食管造影均具有诊断价值。所有患者均行环咽肌切开术，60%患者行憩室固定术，40%患者行憩室切除术。肌切开术中发生1例黏膜穿孔，但术后第一周有3例发生食管瘘。所有3例均接受药物治疗，于术后第7至21天愈合。1例患者发生急性心肌梗死，无死亡病例。在14例患者（93.3%）的随访中，症状消失，其余1例患者有轻微吞咽困难。
有症状的患者应接受Zenker憩室的手术治疗。食管X线检查是最佳诊断工具。环咽肌切开术是手术治疗的关键，可根据憩室及患者的体格和临床特征，联合内翻术、憩室切除术或憩室固定术。超过90%的手术患者效果良好，发病率低且无死亡病例。
