Rosati R, Fumagalli U, Bona S, Bonavina L, Peracchia A
Istituto Clinico Humanitas-Milano, Division of General and Minimally Invasive Surgery, Milan, Italy.
Ann Surg. 1998 Feb;227(2):174-8. doi: 10.1097/00000658-199802000-00004.
To describe the technique and the results of laparoscopic diverticulectomy combined with esophageal myotomy and antireflux wrap for epiphrenic diverticula of the esophagus.
The epiphrenic diverticulum of the esophagus is a rare disease probably caused by a longstanding impairment of the esophageal motor activity. Although there is almost universal agreement to operate only on symptomatic patients, the optimal treatment is controversial. The best-accepted guideline is to treat the underlying motor disorder. This is generally done through a left thoracotomic approach that allows diverticulectomy, esophageal myotomy, and partial fundoplication.
From January 1994 through February 1996, 4 patients underwent laparoscopic transhiatal diverticulectomy, esophageal myotomy, and partial fundoplication at our institution. A thorough preoperative study was done with barium swallow, esophagoscopy, and manometry in all patients; 24-hour pH monitoring was done in one case.
No postoperative complications were observed. Short- and medium-term results are satisfactory.
No theoretical objection should be made to this approach, because the principle of treatment of the diverticular pouch and the underlying motor disorder and the prevention of reflux is respected. Longer follow-up and a wider series are mandatory to substantiate these initially favorable results.
描述腹腔镜下憩室切除术联合食管肌层切开术及抗反流包绕术治疗食管膈上憩室的技术及结果。
食管膈上憩室是一种罕见疾病，可能由食管运动功能长期受损引起。尽管几乎普遍认为仅对有症状的患者进行手术，但最佳治疗方法仍存在争议。目前最被认可的指导原则是治疗潜在的运动障碍。这通常通过左胸切开术来完成，该手术可进行憩室切除术、食管肌层切开术和部分胃底折叠术。
1994年1月至1996年2月，我院4例患者接受了腹腔镜经裂孔憩室切除术、食管肌层切开术和部分胃底折叠术。所有患者均进行了钡餐、食管镜检查和测压等全面的术前检查；1例患者进行了24小时pH监测。
未观察到术后并发症。短期和中期结果令人满意。
对该方法不应存在理论上的异议，因为其遵循了憩室囊袋、潜在运动障碍的治疗原则以及预防反流的原则。需要更长时间的随访和更大规模的病例系列来证实这些初步的良好结果。
