CAJ | 학술논문

目的比较食管肌层切开术加不同胃底折叠术式治疗贲门失弛缓症或弥漫性食管痉挛的远期效果.方法 1978年1月至1998年10月,共64例贲门失弛缓症或弥漫性食管痉挛患者经左胸行Heller手术+抗反流手术.其中21例加行Nissen全胃底折叠术(Nissen组),43例加行BelseyⅣ式部分胃底折叠术(Belsey组).患者于手术前后行影像学、食管核素排空、食管压力测定和内窥镜检查及24 h pH值监测.结果全组无手术死亡及严重并发症.术后6年随访,Nissen组吞咽困难(P=0.025)及核素潴留(P=0.044)的发生率高于Belsey组.两种术式均可降低食管下括约肌的压力梯度.Nissen组术后食管直径较术前增加(P=0.012),而Belsey组增加不明显(P=0.695).两组烧心与反酸症状均少见.Nissen组有8例患者、Belsey组有1例患者因复发性吞咽困难需行二次手术(P＜0.01).结论在治疗贲门失弛缓症或弥漫性食管痉挛患者时,加行全胃底折叠术可能并不适宜,而部分胃底折叠术可以提供满意的抗反流效果,且不会显著影响食管排空功能.
목적 비교식관기층절개술가불동위저절첩술식치료분문실이완증혹미만성식관경련적원기효과.방법 1978년1월지1998년10월,공64례분문실이완증혹미만성식관경련환자경좌흉행Heller수술+항반류수술.기중21례가행Nissen전위저절첩술(Nissen조),43례가행BelseyⅣ식부분위저절첩술(Belsey조).환자우수술전후행영상학、식관핵소배공、식관압력측정화내규경검사급24 h pH치감측.결과 전조무수술사망급엄중병발증.술후6년수방,Nissen조탄인곤난(P=0.025)급핵소저류(P=0.044)적발생솔고우Belsey조.량충술식균가강저식관하괄약기적압력제도.Nissen조술후식관직경교술전증가(P=0.012),이Belsey조증가불명현(P=0.695).량조소심여반산증상균소견.Nissen조유8례환자、Belsey조유1례환자인복발성탄인곤난수행이차수술(P＜0.01).결론 재치료분문실이완증혹미만성식관경련환자시,가행전위저절첩술가능병불괄의,이부분위저절첩술가이제공만의적항반류효과,차불회현저영향식관배공공능.
Objective To compare the long-term results of total and partial fundoplication on nlyotomized esoDhagus.Methods From January 1978 to October 1998,64 patients with achalasia or diffuse esophageal spasm underwent esophagomyotomy and antireflux operation via left thoraeotomy.Twenty-one Datients underwent Nissen total fundoplication(Nissen group)and 43 patients underwent Belsey Marker Ⅳ partial fundoplieation(Belsey group). Clinical,radiologic,radionuclide transit,manometric,24-hour pH monitoring and endoscopic assessments were performed before and after the operation.Results There was no operative death and major complications for either group.At over 6 years follow-up and compared to Belsey group, patients in Nissen group revealed a higher frequency of dysphagia(P=0.025)and more radionuclide material retention(P=0.044).Both operative procedures reduced the lower esophageal sphincter pressure gradient. However,in Nissen group,the esophageal diameter observed on radiology was signifieanfly increased from 3.9 cm preoperatively to 5.5 cm postoperatively(P=0.012),while it kept the same for Belsey group(from 5.4 to 5.3 cm,P=0.695).Reoperation in order to relieve the recurrent dysphagia and esophageal obstruction was performed on 8 patients in Nissen group and 1 in Belsey group (P＜0.01).Conclusion When treating achalasia or diffuse esophageal spasm by esophageal myotomy and an antireflttx operation.a total fundoplication is not appropriate,whereas a partial fundoplication provides proper antireflux effect without significant esophageal emptying difficulty.