ESOPHAGEAL DIVERTICULA - PHYSIOPATHOLOGICAL BASIS FOR SURGICAL-MANAGEMENT

被引：26

作者：

DUGO, D ^{[1
]}

CARDILLO, G ^{[1
]}

GRANONE, P ^{[1
]}

COPPOLA, R ^{[1
]}

MARGARITORA, S ^{[1
]}

PICCIOCCHI, A ^{[1
]}

机构：

[1] UNIV CATTOLICA SACRO CUORE, DEPT SURG, I-00168 ROME, ITALY

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1992年 / 6卷 / 06期

关键词：

ESOPHAGUS; ESOPHAGEAL DIVERTICULA; SURGERY;

D O I：

10.1016/1010-7940(92)90150-V

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

From 1980 to 1990, 31 patients were treated surgically in our department for esophageal diverticula: 12 Zenker's diverticula (ZD); 11 mid-thoracic diverticula (MTD); 8 epiphrenic diverticula (ED). Cricopharyngeal dysfunction was detectable in 8 of 12 ZD patients (66.6%). Cricopharyngeal myotomy with diverticulectomy was performed in all cases. There were no deaths. Relief of dysphagia was obtained in all cases. No recurrences of dysphagia or diverticulum were observed at a mean follow-up of 3 years. A motility disorder was observed in 10 of 11 MTD (90.9%). An extended esophageal myotomy with diverticulectomy was performed in 3 cases, an extended myotomy alone in 3 cases, a diverticulectomy alone in 5 cases; an anti-reflux procedure was added in 6 cases. One patient died on the 7th postoperative day. All remaining patients were free of symptoms at a mean follow-up of 3.2 years. A motor dysfunction was detected in all 8 ED patients (100%). No diverticulectomy was performed. Six patients underwent Heller-Dor myotomy and 2 underwent Nissen fundoplication. There were no deaths. Relief of symptoms was obtained in all patients, at a mean follow-up of 3.1 years. Myotomy with diverticulectomy represents the treatment of choice in ZD. As regards MTD and ED, the treatment of the underlying motor disorder is the main therapeutic goal, whereas diverticulectomy is reserved to selected patients.

引用

页码：330 / 334

页数：5

共 28 条

[1]

Allen T.H., Clagett O.T., Changing concepts in the surgical treatment of pulsion diverticula of the lower esophagus, J Thorac Cardiovasc Surg, 50, pp. 455-462, (1965)

[2]

Bancewicz J., Osugi H., Marples M., Clinical implications of abnormal oesophageal motility, Br J Surg, 74, pp. 416-419, (1987)

[3]

Barthlen W., Feussner H., Hannig C., Holscher A.H., Siewert J.R., Surgical therapy of Zenker‘s diverticulum: Low risk and high efficiency, Dysphagia, 5, pp. 13-19, (1990)

[4]

Belsey R., Functional disease of the esophagus, J Thorac Cardiovasc Surg, 52, pp. 164-168, (1966)

[5]

Borrie J., Wilson R.L.K., Oesophageal diverticula: Principles of management and appraisal of classification, Thorax, 35, pp. 759-767, (1980)

[6]

Bowdler D.A., Stell P.M., Surgical management of posterior pharyngeal pulsion diverticula: Inversion vs. one-stage excision, Br J Surg, 74, pp. 988-990, (1987)

[7]

Debas H.T., Payne W.S., Cameron A.J., Carlson H.C., Physio-pathology of lower esophageal diverticulum and its implications for treatment, Surg Gynecol Obstet, 151, pp. 593-600, (1980)

[8]

Decktor D.L., Allen M.L., Robinson M., Esophageal motility, heartburn, and gastroesophageal reflux: Variations in clinical presentation of esophageal dysphagia, Dysphagia, 5, pp. 211-215, (1990)

[9]

Dohlman G., Endoscopic operations for hypopharyngeal diverticula, Proc. 4th Int. Congress Otolaryngol, (1949)

[10]

Evander A., Little A.G., Ferguson M.K., Skinner D.B., Diverticula of the mid-and lower esophagus: Pathogenesis and surgical management, World J Surg, 10, pp. 820-828, (1986)

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