Picchio M, Lombardi A, Zolovkins A, Della Casa U, Paolini A, Fegiz G, Mihelson M
1st Department of Surgery, University of Rome La Sapienza, Italy.
Int Surg. 1997 Apr-Jun;82(2):198-200.
Retrospective analysis of the results of esophagojejunogastrostomy in 21 patients with peptic stenosis after esophagomyotomy for achalasia is reported. All patients complained of severe dysphagia. The esophagogram showed the presence of a 2 to 3 cm long stenosis in the lower esophagus with a diameter < 10 mm. Endoscopic dilatation was possible in 18 cases and it was pursued until the passage of the endoscope was possible. Manometry confirmed the presence of an aperistaltic esophagus with incompetent LES in all cases examined. GERD was detected by 24 hour pH-metry in 15/21 patients (71.4%). One patient died because of postoperative cardiopulmonary failure. Other minor complications occurred in 6 patients. During an 11 year mean follow-up good results were achieved in 17 patients (85%), fair in 2 (10%) and poor in 1 (5%), in whom redundant jejunal loop was resected after 8 years. Resective surgery in peptic strictures after esophagomyotomy is the treatment that guarantees the best long-term results. Esophagojejunogastroplasty represents a valid technique. Careful selection of patients and an accurate surgical technique are fundamental to reduce mortality and morbidity.
报告了对21例贲门失弛缓症食管肌切开术后消化性狭窄患者行食管空肠胃吻合术结果的回顾性分析。所有患者均主诉严重吞咽困难。食管造影显示食管下段存在2至3厘米长的狭窄，直径<10毫米。18例患者可行内镜扩张，并持续进行直至能通过内镜。测压证实所有检查病例均存在无蠕动的食管且LES功能不全。通过24小时pH监测在15/21例患者（71.4%）中检测到胃食管反流病。1例患者因术后心肺衰竭死亡。6例患者出现其他轻微并发症。在平均11年的随访中，17例患者（85%）效果良好，2例（10%）效果尚可，1例（5%）效果差，该例患者在8年后切除了多余的空肠袢。食管肌切开术后消化性狭窄的切除手术是保证最佳长期效果的治疗方法。食管空肠胃成形术是一种有效的技术。仔细选择患者和精确的手术技术对于降低死亡率和发病率至关重要。
