Akalazya: Cerrahi olarak tedavi edilen 6 olgunun irdelenmesi
Achalasia: Analysis of six cases treated surgically
Özet
Giris ve amaç: Akalazya, etiyolojisi bilinmeyen, özofagusun primer motilite bozuklugudur. Bu çalismada klinigimizde akalazya tanisi konulan olgularin tedavi algoritmi retrospektif olarak irdelenmistir. Gereç ve yöntem: Eylül 1996- Kasim 2002 tarihleri arasinda , klinigimizde akalazya tanisi konulan ve tedavi edilen 6 olgu, yas, cinsiyet, semptom, üst gastrointestinal endoskopi ve özofagus,mide , duodenum pasaj grafileri, manometrik ölçümleri, uygulanan endoskopik ve cerrahi tedavi yöntemleri ve izlem sonuçlari açisindan degerlendirildi. Bulgular: Olgularin tümü erkek olup yas ortalamasi 47,9(31-69) idi. Yutma güçlügü tüm olgularda primer semptom olup, 5 olguda retrosternal yanma ve 3 olguda da regürjitasyon mevcuttu. Olgularin tümünde pasaj grafileri akalazyayla uyumlu olup, 5 olguda da endoskopi ile tani konuldu. Dört olguya pnömotik dilatasyon uygulanmis olup, tedavi sonrasi semptomlarin tekrar etmesi üzerine cerrahi uygulandi.Iki olguda ise cerrahi primer tedavi olarak yapildi.Olgularda mortaliteye rastlanilmadi. Sonuç:Akalazyanin tedavisinde ; endoskopik pnömotik dilatasyon ilk tercih edilen tedavi yöntemi olup, 40 yas altinda, ek cerrahi hastaligi olan ve pnömotik dilatasyon sonrasi semptomlari tekrarlayan olgularda cerrahi yapilmalidir.
Abstract
Background and aims: Achalasia is a primary motility disorder of the esophagus with unknown etiology. In this retrospective study, we evaluated the treatment algorithm of achalasia in our clinic. Materials and methods: Between September 1996 and November 2002, the patients treated due to achalasia were evaluated according to age, sex, symptom, upper gastrointestinal endoscopy findings, upper gastrointestinal series, lower esophageal sphincter pressure measurement, and treatment modalities (whether endoscopic pneumatic dilatation or surgery). Results: All patients were male with a mean age of 47.9(31-69). The primary symptom was dysphagia in all patients, retrosternal heartburn in 5 and regurgitation in 3. Upper gastrointestinal series showed achalasia in all patients, and endoscopy also supported the diagnosis in 5 patients. In 2 young patients, surgery was the first choice of treatment and in 4 patients, endoscopic pneumatic dilatation was done for relief of symptoms. There was no mortality. Conclusion: Endoscopic pneumatic dilatation is the first choice of treatment in achalasia but surgery is suitable in patients younger than 40 years old, with coexistence of surgical disease and recurrence of symptoms after endoscopic pneumatic dilatation.
