Esophageal function changes and symptom relief after video-assisted thoracoscopic surgery for achalasia of cardia_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHU Xu ,  XIAO Jiarong , RAN Peng , LIU Wen , ZHANG Jian

Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, P.R.China;

Corresponding?author：

XIAO Jiarong, Email: zhu0226zx@sina.com

Keywords：

Achalasia; video-assisted thoracoscopic surgery; esophageal manometry

DOI：

10.7507/1007-4848.201511054

Video：

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Objective Through a retrospective study on esophageal function changes and symptom relief after video-assisted thoracoscopic surgery treatment for achalasia of cardia (AC) to assess the clinical value of this operation. Methods We reviewed the data of 34 AC patients who received modified Heller operation by video-assisted thoracoscopic surgery in the Affiliated Hospital of Guizhou Medical University from March 2012 to September 2014. There were 11 males and 23 females with a median age of 35 (11–67) years. These patients were divided into four groups according to the time of treatment and follow-up: preoperative group, postoperative one-month group, postoperative three-month group and postoperative six-month group. Changes of symptoms, radiography and esophageal dynamics before and after therapy were collected. These different groups were analyzed based on statistical methods. Results There was no statistical difference in ages and genders among groups (P>0.05). The surgery was successful and no complication or death occurred. Symptoms of patients showed different degrees of relief and the postoperative grade of clinical symptoms decreased (P<0.05). After surgery, lower esophageal sphincter pressure (LESP), lower esophageal sphincter resting pressure (LESRP) and esophageal body pressure (EBP) decreased significantly, while lower esophageal sphincter relax rate (LESRR) increased (P<0.05). While there was no significant difference in length of lower esophageal sphincter (LESL,P>0.05). Angiography of upper digestive tract revealed that compared to the preoperative group, the maximum width in postoperative three-month group decreased significantly (P<0.05). During the follow-up, 3 patients suffered gastroesophageal reflux, 2 patients esophageal perforation and 1 patient empyema due to esophago-pleural fistula. No massive hemorrhage of upper digestive tract and hiatal hernia occured. Conclusion Sugery can significantly ameliorate the clinical symptoms of the patients with AC, and improve esophageal dynamics. And it is simple and easy to perform with less complications and better long-term outcomes. Improved Heller operation by video-assisted thoracoscopy is a less invasive procedure when compared with the traditional thoracotomy. Moreover, esophageal manometry can objectively assist in the diagnosis and degree of the disease and effect of therapy.

Citation： ZHU Xu, XIAO Jiarong, RAN Peng, LIU Wen, ZHANG Jian. Esophageal function changes and symptom relief after video-assisted thoracoscopic surgery for achalasia of cardia. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(6): 450-455. doi: 10.7507/1007-4848.201511054 Copy

1.	吳孟超, 吳在德, 主編. 黃家駟外科學(中冊). 北京: 人民衛生出版社, 2008. 2093-2094.
2.	Richter JE. Oesophageal motility disordersers. Lancet, 2001, 358: 823.
3.	廖祥麗, 蔣耀光, 王如文, 等. 食管測壓及 24 小時食管 pH 監測的臨床應用. 中國胸心血管外科臨床雜志, 2004, 11(2): 151-152.
4.	Litle VR. Laparoscopic Heller myotomy for achalasia: a review of the controversies. Ann Thorac Surg, 2008, 85(2): S743-S746.
5.	Kesler Ka, Tarvin SE, Brooks JA. Thoracoscopy-assisted Heller myotomy for the treatment of achalasia: results of a minimally invasive technique. Ann Thorac Surg, 2004, 77(2): 385-391.
6.	羅金燕, 牛春燕. 功能性胃腸病與胃腸動力疾病的新概念. 中華消化雜志, 2002, 22(9): 554.
7.	陳焰, 宋震亞, 唐訓球, 等. 食管測壓在賁門失弛緩癥診治中的應用及評價. 中國實用內科雜志, 2004, 24(4): 229-230.
8.	Ragunath K, Williams JG. A review of oesophageal manometry testing in a district general hospital. Postgrad Med J, 2002, 78(951): 34-36.
9.	曹辛. 先天性食管旁疝 7 例臨床分析. 中國現代醫學雜志, 2000, 10(9): 4-5.
10.	Ellis FH. Treatment of achalasia: A continuing controversy. Ann Thorac Surg, 1988, 45: 473.
11.	王如文, 蔣耀光, 范士志. 食管失弛緩癥的外科治療. 重慶醫學, 1994, 23(2): 78.
12.	Malthaner RA, Tood TR, Miller L, et al. Long-term results in surgically managed esophageal achalasia. Ann Thorac Surg, 1994, 58: 1343.
13.	張瑋. 賁門失弛癥 133 例的外科治療. 中華外科雜志, 1984, 22(3): 171-172.
14.	黃孝邁, 主編. 手術學全集 (胸外科卷). 北京: 人民衛生出版社, 1995. 254.
15.	徐啟明, 孫玉鄂, 黃孝邁, 等. 賁門失弛緩癥的外科治療. 中華胸心血管外科雜志, 1993, 9(2): 98-99.
16.	Andreollo NA, Earlarn RJ. Heller’s myolomy for achalasia: is an added anti-rellux procedure Necessary? Hr J Surg, 1987, 74(9): 765-769.
17.	劉古霧, 孫建華. 賁門失弛緩癥: 130 例食管肌層切開術后遠期療效的主客觀評價. 國外醫學外科學分冊, 1989, 3(4): 191.
18.	Vantrappen G, Hellemans J. Treatment of achalasia and related motor disorder. Gasroenterology, 1980, 79(1): 144-154.
19.	Jara FM, Toledo-Pereyra LH, Lewis JW, et al. Long-term results of esophagomyotomy for achalasia of esophagus. Arch Surg, 1979, 114(8): 935-938.
20.	Csendes A, Braghetto I. May the risk of reflux esophagitis dilatation? In: Giuli R, Mc Callum RW, Skinner DB, et al. eds. Primary motility disorders of the esophagus. Paris: John Libbey Eurotext, 1991. 477-481.
21.	Cargill G, Duche M. What is the incidence of reflux in achalasia? In: Giuli R, eds. Benign lesions of the esophagus and cancer. Berlin: Springer, 1989. 41-43.

1. 吳孟超, 吳在德, 主編. 黃家駟外科學(中冊). 北京: 人民衛生出版社, 2008. 2093-2094.
2. Richter JE. Oesophageal motility disordersers. Lancet, 2001, 358: 823.
3. 廖祥麗, 蔣耀光, 王如文, 等. 食管測壓及 24 小時食管 pH 監測的臨床應用. 中國胸心血管外科臨床雜志, 2004, 11(2): 151-152.
4. Litle VR. Laparoscopic Heller myotomy for achalasia: a review of the controversies. Ann Thorac Surg, 2008, 85(2): S743-S746.
5. Kesler Ka, Tarvin SE, Brooks JA. Thoracoscopy-assisted Heller myotomy for the treatment of achalasia: results of a minimally invasive technique. Ann Thorac Surg, 2004, 77(2): 385-391.
6. 羅金燕, 牛春燕. 功能性胃腸病與胃腸動力疾病的新概念. 中華消化雜志, 2002, 22(9): 554.
7. 陳焰, 宋震亞, 唐訓球, 等. 食管測壓在賁門失弛緩癥診治中的應用及評價. 中國實用內科雜志, 2004, 24(4): 229-230.
8. Ragunath K, Williams JG. A review of oesophageal manometry testing in a district general hospital. Postgrad Med J, 2002, 78(951): 34-36.
9. 曹辛. 先天性食管旁疝 7 例臨床分析. 中國現代醫學雜志, 2000, 10(9): 4-5.
10. Ellis FH. Treatment of achalasia: A continuing controversy. Ann Thorac Surg, 1988, 45: 473.
11. 王如文, 蔣耀光, 范士志. 食管失弛緩癥的外科治療. 重慶醫學, 1994, 23(2): 78.
12. Malthaner RA, Tood TR, Miller L, et al. Long-term results in surgically managed esophageal achalasia. Ann Thorac Surg, 1994, 58: 1343.
13. 張瑋. 賁門失弛癥 133 例的外科治療. 中華外科雜志, 1984, 22(3): 171-172.
14. 黃孝邁, 主編. 手術學全集 (胸外科卷). 北京: 人民衛生出版社, 1995. 254.
15. 徐啟明, 孫玉鄂, 黃孝邁, 等. 賁門失弛緩癥的外科治療. 中華胸心血管外科雜志, 1993, 9(2): 98-99.
16. Andreollo NA, Earlarn RJ. Heller’s myolomy for achalasia: is an added anti-rellux procedure Necessary? Hr J Surg, 1987, 74(9): 765-769.
17. 劉古霧, 孫建華. 賁門失弛緩癥: 130 例食管肌層切開術后遠期療效的主客觀評價. 國外醫學外科學分冊, 1989, 3(4): 191.
18. Vantrappen G, Hellemans J. Treatment of achalasia and related motor disorder. Gasroenterology, 1980, 79(1): 144-154.
19. Jara FM, Toledo-Pereyra LH, Lewis JW, et al. Long-term results of esophagomyotomy for achalasia of esophagus. Arch Surg, 1979, 114(8): 935-938.
20. Csendes A, Braghetto I. May the risk of reflux esophagitis dilatation? In: Giuli R, Mc Callum RW, Skinner DB, et al. eds. Primary motility disorders of the esophagus. Paris: John Libbey Eurotext, 1991. 477-481.
21. Cargill G, Duche M. What is the incidence of reflux in achalasia? In: Giuli R, eds. Benign lesions of the esophagus and cancer. Berlin: Springer, 1989. 41-43.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Esophageal function changes and symptom relief after video-assisted thoracoscopic surgery for achalasia of cardia

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