Del Genio A, Izzo G, Di Martino N, Maffettone V, Landolfi V, Martella A, Barbato D
Department of Digestive Surgery, School of Medicine, Second University of Naples, Italy.
Dis Esophagus. 1997 Oct;10(4):253-61. doi: 10.1093/dote/10.4.253.
In order to improve the results of functional surgical procedures on the esophagus, the authors, after a number of experimental studies, proposed the use of intraoperative esophageal manometry (IEM). The technique was performed for the first time in 1972. IEM has been employed in the course of Heller's cardiamyotomies and Nissen-Rossetti (N-R) fundoplications, respectively, to document the ablation of the lower esophageal sphincter (LES) high-pressure zone (HPZ) and to calibrate the pressure of the fundal wrap between values ranging from 20 to 40 mmHg ('hypercalibrated Nissen'). This hypercalibration resulted from the retrospective evaluation of a former series when, at the beginning of our experience, we used to calibrate the fundoplication to pressure values similar to those of a normal sphincter ('normocalibrated Nissen': 10-20 mmHg). This experience, in fact, was followed by a high rate of gastroesophageal reflux (GER) recurrence (28.5%) in the first 12 months after surgery. Since 1985 to date, IEM has been employed in the course of 309 functional surgical procedures on the esophagus. This paper, however, reports on 281 patients: 144 with achalasia treated with Heller's myotomy + Nissen-Rossetti fundoplication and 137 with gastroesophageal reflux disease (GER-D) submitted to Nissen-Rossetti fundoplication. Our data suggest that IEM can be a useful tool in the field of functional surgery of the esophagus, and its routine use seems to be able to improve the postoperative results. In this series, in fact, IEM was able to detect the persistence of an HPZ in 15.2% of apparently complete myotomies, all performed with the aid of intraoperative endoscopy. As regards the manometric calibration of the n-HPZ, our results seem to confirm the validity of the technique, yet some findings still remain unexplained: i.e. two patients with a hypotonic n-HPZ and GER recurrence and two with an n-HPZ, exceeding 20 mmHg with postoperative persistent dysphagia. Finally, we would like to emphasize that the concept of a 'hypercalibrated Nissen' contrasts with the 'floppy Nissen' of Donahue and DeMeester; our wrap is also loose around the esophagus and does not impair the esophagogastric transit.
为提高食管功能性外科手术的效果，作者在进行了多项实验研究后，提出术中食管测压（IEM）的应用。该技术于1972年首次实施。IEM已分别应用于海勒贲门肌切开术和nissen - rossetti（N - R）胃底折叠术过程中，以记录食管下括约肌（LES）高压区（HPZ）的消除情况，并将胃底折叠的压力校准到20至40 mmHg之间（“超校准nissen术”）。这种超校准源于对之前一系列病例的回顾性评估，在我们经验初期，我们常将胃底折叠术校准到与正常括约肌相似的压力值（“正常校准nissen术”：10 - 20 mmHg）。事实上，在这种经验之后，术后12个月内胃食管反流（GER）复发率很高（28.5%）。自1985年至今，IEM已应用于309例食管功能性外科手术过程中。然而，本文报告了281例患者：144例贲门失弛缓症患者接受了海勒肌切开术 + Nissen - Rossetti胃底折叠术，137例胃食管反流病（GER - D）患者接受了Nissen - Rossetti胃底折叠术。我们的数据表明，IEM在食管功能性外科领域可能是一种有用的工具，其常规应用似乎能够改善术后效果。在本系列中，实际上，IEM能够在15.2%明显完整的肌切开术中检测到HPZ的持续存在，所有这些肌切开术均借助术中内镜进行。关于n - HPZ的测压校准，我们的结果似乎证实了该技术的有效性，但仍有一些发现无法解释：即两名患者n - HPZ张力低下且GER复发，两名患者n - HPZ超过20 mmHg且术后持续吞咽困难。最后，我们想强调，“超校准nissen术”的概念与多纳休和德梅斯特的“松弛nissen术”不同；我们的胃底折叠在食管周围也是宽松的，不会妨碍食管胃的通过。
