胸腔镜联合小切口改良Heller术治疗贲门失弛症  

Modified Heller myotomy for achalasia by thoracoscopy

作　　者：张辅贤[1] 单根法[1] 钟竑[1] 戚晓敏[1] 李国庆[1] 隆桂麟[1] 

机构地区：[1]上海第二医科大学新华医院胸心外科,上海200092

出　　处：《上海第二医科大学学报》2004年第7期556-558,共3页Acta Universitatis Medicinalis Secondae Shanghai

摘　　要：目的 探讨胸腔镜联合小切口手术治疗贲门失弛症。方法 45例贲门失弛症患者经病史、食管镜和食管钡餐造影确诊,胸腔镜下加小切口进行改良Heller手术,随访并监测术后食管压力和pH值。结果 2例因术中食管粘膜破损改行开胸术,平均手术时间1.9 h(1.0-3.8 h),未发生术后食管瘘和手术死亡,所有患者于胃肠道功能恢复后即可常规进食,症状消失。随访35例优(78％),7例良(16％),3例劣(6％)因吞咽困难复发于术后3个月行食管扩张,4例(9％)患者出现返流,但不需手术或药物治疗。食管压力和pH值监测结果与患者临床表现相符。结论 胸腔镜治疗贲门失弛症具有良好效果。Objective We report our experience concerning the treatment of achalasia by using thoracoscopy. Methods Forty-five patients suffering from esophageal achalasia were diagnosed by clinical history, esophagoscopy and barium esophagogram. Modified Heller myotomy was done under thoracoscopiy combined with minimal incision. All patients were followed-up. The esophageal pressure and pH value were monitored. Results Conversion to an open procedure took place in 2 patients because the mucosa were broken. The mean operative time was 1.9 h (1.0 -3.8 h). There was no postoperative esophageal leakage nor operative or in-hospital death. All patients ate a regular diet as soon as the gastrointestinal function was resumed and all symptoms disappeared. At the last follow-up, the patient's condition status was: excellent ( n =35, 78% ) ; good(n =7, 16% ) ; fair( n =3,6% ) and required esophageal dilation for symptoms of recurrent dysphagia 3 months after operation. Four patients (9% ) had some regurgita-tion, but did not need surgical or medical treatment. The results of the esophageal pressure and pH value monitoring were matched with clinical manifestation. Conclusion The results confirm that thoracoscopy for achalasia may have a favorable outcome.

关 键 词：胸腔镜 HELLER术 贲门失弛症 手术治疗 

分 类 号：R655[医药卫生—外科学]