胸腔镜下食管肌层切开术治疗贲门失弛缓症  

The clinical experience of thoracoscopic Heller myotomy for achalasia

作　　者：蒋伟[1] 王群[1] 谭黎杰[1] 徐正浪[1] 郑如恒[1] 

机构地区：[1]复旦大学附属中山医院胸外科,上海200032

出　　处：《复旦学报（医学版）》2007年第2期296-298,共3页Fudan University Journal of Medical Sciences

摘　　要：目的 探讨胸腔镜食管肌层切开术（Heller）治疗贲门失弛缓症的手术方法和效果.方法 对1997年至2006年的30例贲门失弛缓症患者行胸腔镜Heller手术治疗,并进行随访.结果 全组无手术死亡.2例术中发生食管穿孔,其中1例胸腔镜下修补成功,另1例改行Muscle-Sparing剖胸切口进行修补后愈合,1例在术后第一天发生食管穿孔后开胸修补,仍继发脓胸,经积极治疗后愈合,并发症发生率为10%（3/30）.排除学习曲线的影响,1999年至今26例患者术后住院时间为6～11 d,平均为6.7 d;手术时间为57～94 min,平均为（74.7±13.2）min.术后随访,所有患者吞咽困难症状均有不同程度改善.术后1个月24例患者综合症状VAS评分由术前的6.8±1.6降至1.6±0.9（P-＜0.05）;随访至6个月的21例患者VAS评分降至1.6±0.8（P＜0.05）.结论 胸腔镜下Heller术可作为贲门失弛缓症的首选治疗方法,术中合理使用纤维胃镜可进一步减少并发症的发生率.Purpose To report the outcome of thoracoscopic Heller myotomy for achalasia. Methods From 1997 to 2006, 30 patients had been undergone thoracoscopic Heller myotomy. All the patients were prospectively followed up. Results The operative time ranged from 57 to 94 minutes, with mean time 74. 7 minutes. Two esophageal perforations occured during operation, one was repaired successfully with thoracoseopy, the other was repaired by conversion to Muscle-Sparing thoracotomy. One esophageal leak, which occurred the first day after surgery, turned to empyema after open chest repairment. The morbidity was 10% （3/30）. The postoperative hospital stay was 6 to 11 days, averaged 6.7 days. All patients were relieved dysphagia from thoracoscopic Heller myotomy. VAS evaluation of 24 patients decreased from preoperative 6.8 ± 1.6 to postoperative 1 month 1.6 ± 0.9 （P〈0.05） and 6 months 1.6 ± 0.8 （P〈 0. 05）. No death occurred. Conclusions Thoracoscopic Heller myotomy could be the first choice for achalasia. Timely using flexible endoscope during operation can reduce morbidity.

关 键 词：贲门失弛缓症 胸腔镜 食管肌层切开术 

分 类 号：R655.4[医药卫生—外科学]