非腐蝕性相關之老年食道良性狹窄的手術

Surgical Approaches to Non-Caustic Benign Esophageal Stenosis in the Elderly

描述非腐蝕性相關之老年食道良性狹窄的手術。在15 個月內，有六位老年患者罹患非腐蝕性相關之食道良性狹窄：包括環咽壓跡，消化性食道狹窄，食道失弛症，及復發性食道失弛症。他們年齡介於66 及83 歲，平均為77.3 歲。吞嚥困難的時間介於5 個月至30 年平均為16 年。外科手術包括：咽肌切開術，遠端食道切除、食道胃幽門成形術、胃底折疊術之縱合手術，以結腸做食道重建，胸腔鏡食道肌切開術。所有患者完成手術後恢復正常飲食。有一個手術併發症，是十二指腸潰瘍出血，其治療是以內視鏡進行電燒止血。老年人罹患非腐蝕性相關之食道良性狹窄，常被延誤診斷和治療。手術方法依食道疾病的部位和性質有所差異。細心手術可以讓患者的生活品質提昇。

This report describes surgical approaches to non-caustic benign esophageal stenosis in the elderly. In a 15-month period, 6 elderly patients with non-caustic related benign esophageal stenosis, including cricopharyngeal bar (n=1), peptic stricture (n=2), achalasia (n=1), and recurrent achalasia (n=2), were enrolled. Their mean age was 77.3 with a range between 66 and 83. Mean duration of dysphagia was 16 years with a range of 5 months up to 30 years. Surgical procedures consisted of pharyngoesophageal myotomy (n=1), a combination of distal esophagectomy, esophagogastrostomy and pyloroplasty with fundoplication (n=3), colon interposition (n=1) and thoracoscopic myotomy (n=1). All patients resumed regular diet after completion of surgery. There was one operative complication involving duodenal ulcer bleeding which was controlled by endoscopic coagulation. Delayed diagnosis and treatment of non-caustic related benign esophageal stenosis are common in the elderly. The surgical approach depends on the location and nature of the esophageal disease. Patients’quality of life can benefit from careful surgery.