贲门失弛症外科手术后再手术问题探讨  

INVESTIGATION OF REOPERATION AFTER FAILED CARDIOMYOTOMY FOR ACHALASIA

作　　者：张少为[1] 刘俊峰[1] 王其彰[1] 

机构地区：[1]河北医科大学第四医院胸外科,河北石家庄050011

出　　处：《河北医科大学学报》2010年第9期1062-1064,共3页Journal of Hebei Medical University

摘　　要：目的探讨贲门失弛症外科手术后再手术的原因和再手术方法。方法回顾性分析河北医科大学第四医院胸外科1993年1月—2009年12月行贲门肌层切开术后再手术患者共5例。结果 5例患者第1次手术均行贲门肌层切开加抗反流术,术后出现吞咽困难;第2次手术中发现贲门肌层切开长度和广度不足、瘢痕挛缩和不适的抗反流手术,是首次手术失败的主要原因。并进一步行贲门肌层切开术,其上界至食管胃交接部上方约6cm处,下界越过手术瘢痕,达贲门口下方至少3cm处,向两侧游离达食管周径约3/4,附加Dor手术。术后随访患者满意。结论贲门失弛症患者行贲门肌层切开长度和广度要充分,附加抗反流术宜选用Dor手术。Objective To investigate the cause and method of reoperation after failed cardiomyotomy for achalasia. Methods The clinical data of 5 cases after failed cardiomyotomy for achatasia were retrospectively analysed. Results Cardiomyotomy with anti -reflux operation was performed in the initial operation. Dysphagia recurred after operation. The reasons for failure of the initial operations were incomplete myotomy in length and width, scar conglutination and incorrect anti -reflux procedure. The second myotomy was extended upward 6cm above gastroesophaged junction and downward 3cm below the cardia, both sides 3/4 of whole esophageal circle. Finally Dor fundoplication was performed. Conclusion Complete myotomy in length and width was critical for cardiomyotomy for achalasia and Dor fundoplication was adapted for anti - reflux procedure.

关 键 词：贲门 外科手术 再手术 

分 类 号：R655.4[医药卫生—外科学]