エンドウ シュンジ
Shunji Endo
遠藤 俊治 所属 川崎医科大学 医学部 臨床医学 消化器外科学 職種 准教授 |
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論文種別 | 原著 |
言語種別 | 英語 |
査読の有無 | 査読あり |
表題 | Laparoscopic Heller-Dor surgery for esophageal achalasia: impact of intraoperative real-time manometric feedback on postoperative outcomes. |
掲載誌名 | 正式名:Digestive surgery 略 称:Dig Surg ISSNコード:14219883/02534886 |
掲載区分 | 国外 |
巻・号・頁 | 26(4),pp.342-8 |
著者・共著者 | Endo Shunji, Nakajima Kiyokazu, Nishikawa Kazuhiro, Takahashi Tsuyoshi, Souma Yoshihito, Taniguchi Eiji, Ito Toshinori, Nishida Toshirou |
担当区分 | 筆頭著者 |
発行年月 | 2009/10 |
概要 | BACKGROUND:Laparoscopic Heller myotomy with Dor fundoplication (LHD) is one of the most established surgical procedures for esophageal achalasia. Preoperative esophageal manometry has been reported as useful to evaluate lower esophageal sphincter (LES) pressure. However, the feasibility, safety, and impact of its intraoperative use have not been fully evaluated, especially when enhanced with real-time 3-D pressure imaging.METHODS:LHD was attempted on 24 consecutive patients with esophageal achalasia. Manometry was performed at 3 time points during LHD: before myotomy, after myotomy, and after fundoplication. Investigations included esophagography, manometry, and 24-hour esophageal pH monitoring in the preoperative, short-term (0-5 months) and long-term (1-3 years) follow-up periods.RESULTS:The 3-D intraoperative manometric images were presented to the surgical crew on a monitor screen immediately after each measurement in all attempted cases (n = 13). Any residual high pressure zone of the LES was easily recognized and resolved with additional myotomy. Postoperative esophagographies showed resolution of esophageal dilatation. Manometric examination revealed significant reduction of LES pressure in the short-/long-term follow-up periods. PH monitoring showed no increase in acid reflux. Overall outcomes were satisfactory (symptom relief = 95%).CONCLUSION:Intraoperative manometry with real-time pressure feedback is a feasible, safe, and useful adjunct in LHD. |
DOI | 10.1159/000244512 |
PMID | 19816021 |