原發性或復發性食道賁門失弛緩症的手術

Surgeries for Primary or Recurrent Esophageal Achalasia

在15年內，有20位原發性或復發性食道賁門失弛緩症病人接受外科治療。包括11位女性和9位男性，平均年齡為58.3歲（31至85歲）。總共進行了23次手術，因為其中3名患者復發需重覆手術。手術方式包括胸腔鏡肌切開術（n =12）、腹腔鏡肌切開術（n = 1）、剖腹肌切開術（n = 1）、使用吻合器的食道胃賁門成形術（n = 2）、食道重建術（n = 2）和部分食道胃切除術和食道胃吻合術（n= 5）。沒有死亡病例。一名患者因吸入食物而出現呼吸衰竭，需要進行氣管切開術而需要使用短期呼吸器。所有手術病人術後均恢復正常飲食。三名病人出現復發，需要我們進一步的手術，其中包括兩名原發性賁門失弛緩症病人和一名復發性賁門失弛緩症病人。食道賁門失弛緩症的延遲治療和復發很常見。手術方法應根據疾病的階段和復發情況進行調整。仔細的手術可以顯著改善病人的生活品質。

Over a 15-year period, 20 patients with primary or recurrent esophageal achalasia were treated. This cohort included 11 females and 9 males, with an average age of 58.3 years (range: 31–85). A total of 23 surgeries were performed, as three patients experienced recurrence. The surgical procedures included thoracoscopic myotomy (n = 12), laparoscopic myotomy (n = 1), laparotomy myotomy (n = 1), esophago-cardioplasty using a stapler (n = 2), esophageal reconstruction (n = 2), and partial esophago-gastrectomy with esophago-gastrostomy (n = 5). There were no hospital deaths. One patient developed respiratory failure due to aspiration and required a tracheostomy for temporary mechanical ventilation. All surgical patients resumed a regular diet postoperatively. Three patients experienced recurrence, necessitating further surgical intervention at our facility, including two with primary achalasia and one with recurrent achalasia. Both delayed treatment and recurrence of esophageal achalasia are common. Surgical approaches should be tailored to the disease stage and recurrence of the disease. Careful surgical intervention can significantly improve patients’quality of life.