选择儿童单纯性和复杂性食管失弛缓症的外科手术方法。

Selecting the surgical procedure for simple and complicated esophageal achalasia in children.

作者信息

Porras G, Hernández M H, Izundegui G, Porras J D

机构信息

Unidad Hospitalaria La Paz, Puebla, Mexico.

出版信息

J Pediatr Surg. 1997 Nov;32(11):1595-7. doi: 10.1016/s0022-3468(97)90460-7.

DOI:10.1016/s0022-3468(97)90460-7

PMID:9396533

Abstract

BACKGROUND/PURPOSE: Surgical experience in children who have achalasia is limited. Surgical treatment requires esophagocardiomyotomy and an antireflux procedure. However, when these operations fail, other procedures are needed. To summarize the experience treating children who have this condition, the authors reviewed retrospectively all case histories of patients treated from 1971 to 1996 at their hospital.

METHODS

Three boys and a girl, ranging in age from 18 months to 11 years, were treated. All had multiple previous dilatations. Two then underwent operation using an abdominal approach for a Heller procedure and a posterior fundoplasty (Guarner operation). Two children were previously treated in another hospital. One underwent a Heller operation complicated by perforation of the anterior mucosa. The other had undergone three previous abdominal approaches for esophagocardiomyotomy and a Nissen fundoplication. Symptoms persisted and imaging and endoscopy showed stenosis in both patients. In the first patient an esophagocardioplasty with transverse closure (Wendel procedure) and a posterior fundoplasty was performed. In the second child, the three previous abdominal surgical approaches mandated a transthoracic approach with transdiaphragmatic latero-lateral esophagogastric anastomosis (Heyrowsky operation) and a modified Guarner operation using the remaining fundus and gastric body.

RESULTS

There were no intraoperative or postoperative complications. Follow-up time ranged from 3 months to 17 years. All patients experienced dramatic relief of symptoms and satisfactory weight gain. No recurrence of symptomatology has occurred.

CONCLUSIONS

Esophagocardiotomy associated with an antireflux procedure may be the first option in the surgical treatment of children who have achalasia. However, if this fails, esophagocardioplasty and the latero-lateral esophagogastric anastomosis associated with antireflux procedure may be successful alternatives.

摘要

背景/目的：贲门失弛缓症患儿的手术经验有限。手术治疗需要进行食管贲门肌层切开术和抗反流手术。然而，当这些手术失败时，就需要采取其他手术方法。为总结治疗该疾病患儿的经验，作者回顾性分析了1971年至1996年在其医院接受治疗的所有患者的病历。

方法

治疗了3名男孩和1名女孩，年龄在18个月至11岁之间。所有患儿此前均接受过多次扩张治疗。其中2例采用腹部入路进行了Heller手术和后壁胃底成形术（瓜尔纳手术）。2名患儿曾在另一家医院接受治疗。1例接受Heller手术，并发前黏膜穿孔。另1例此前曾3次采用腹部入路进行食管贲门肌层切开术和nissen胃底折叠术。症状持续存在，影像学和内镜检查显示两名患者均有狭窄。第1例患者进行了横向闭合的食管贲门成形术（温德尔手术）和后壁胃底成形术。第2例患儿，由于此前3次腹部手术入路，此次采用经胸入路，经膈肌外侧食管胃吻合术（海罗夫斯基手术），并利用剩余的胃底和胃体进行改良瓜尔纳手术。