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Surgical treatment for Zenker's diverticulum: comparison between diverticulectomy and diverticulopexy

机译：Zenker憩室的外科治疗：憩室切除术和憩室切开术的比较

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Background The ideal surgical technique for symptomatic Zenker's diverticulum has not been identified yet. Endoscopic treatment, although frequently performed, has not replaced the open cricopharyngeal myotomy, which is still deemed the standard therapy by many dedicated physicians. The management of the diverticular sac after myotomy is still a matter of debate. The aim of this study is to compare the results of diverticulectomy and diverticulopexy after cricopharyngeal myotomy, in homogeneous groups of patients.Methods Thirty-seven patients were treated for Zenker's diverticulum at the same university medical school, but in two different units, with open cricopharyngeal myotomy, associated with diverticulectomy in 17 patients and with diverticulopexy in the remaining. No clinical criteria influenced the different choice of treatment of the diverticular pouch, but only the surgeon's preference. Clinical data, diverticulum size, postoperative course, andcomplications were analyzed. Patients were followed up for median duration of 37 months (range 12-113 months) through contrast swallow study and clinical evaluation, aided by a specifically conceived questionnaire. Records were analyzed by Mann-Whitney-Wilcoxon test and Fisher's exact test.Results Homogeneous comparative values for sex, age, diverticulum size, and symptoms were found in the two groups. Statistical analysis indicated that diverticulopexy, as compared with diverticulectomy, allowed reduced postoperative complications and slightly improved long-term swallowing.Conclusions Diverticulopexy is feasible also in large Zenker's diverticula and can achieve equivalent or even better results than diverticulectomy with a smoother postoperative course.
机译：背景技术尚未确定有症状的Zenker憩室的理想外科手术技术。内窥镜治疗虽然经常进行，但仍不能代替开放式咽喉肌切开术，许多专职医师仍将其视为标准疗法。肌切开术后憩室囊的处理仍是一个争论的问题。这项研究的目的是比较均一的患者在环咽肌切开后的憩室切除术和憩室切开术的结果。方法在同一所大学医学院的37例患者中，对Zenker憩室进行了治疗，但在两个不同的单元中进行了开放性咽咽炎肌切开术，伴有憩室切除术的患者17例，其余伴憩室切开术的患者。没有临床标准会影响憩室囊治疗的不同选择，而只会影响外科医生的偏爱。分析临床资料，憩室大小，术后病程和并发症。通过对比吞咽研究和临床评估，在专门设计的调查表的帮助下，对患者进行了37个月（范围12-113个月）的中位随访。通过Mann-Whitney-Wilcoxon检验和Fisher精确检验对记录进行分析。结果两组均在性别，年龄，憩室大小和症状方面具有均一的比较值。统计分析表明，与憩室切开术相比，憩室切开术可以减少术后并发症，并且长期吞咽略有改善。结论憩室切开术在大型Zenker憩室中也是可行的，并且与术后较平稳的憩室切除术相比，可以获得等效甚至更好的结果。

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