开放和腹腔镜手术治疗儿童贲门失弛缓症疗效的初步比较  

Evaluation of open and laparoscopic Heller＇s procedure for patients with esophageal achalasia

作　　者：周峻[1] 李龙[2] 李索林[3] 黄柳明[4] 张晓伦[2] 孔赤寰[2] 张军[2] 刘树立[2] 吴涛[2] 李颀[2] 董宁[2] 

机构地区：[1]北京协和医学院研究生院 [2]首都儿科研究所,100730 [3]河北医科大学第二医院 [4]北京军区总医院八一儿童医院

出　　处：《中华小儿外科杂志》2010年第12期888-892,共5页Chinese Journal of Pediatric Surgery

基　　金：国家＂十一五＂科技支撑计划2006BAI05A06;2010年北京市科技计划项目

摘　　要：目的 通过回顾经治的贲门失弛缓症手术病例,比较传统的开放Heller手术和腹腔镜手术疗效的差异.方法 2002年10月至2009年10月间共有22例贲门失弛缓症儿童接受手术治疗,按不同的手术方式分为开放手术组（n=12）和腹腔镜手术组（n=10）.2组病例均采用改良的Heller肌层纵行切开术,且全部附加部分胃底折叠术.通过2组术后住院时间、术后进固体食物时间比较2种手术的短期疗效.通过术后随访的症状评分、造影食管上段最大横径差和食管下段最窄横径差等指标,比较2组患儿手术的长期疗效.结果 比较开放手术组和腹腔镜组患儿病程（27.3±23.7和30.7±36.3）、术前症状评分（5.7±2.4和6.1±1.9）,差异均无统计学意义（P=0.796,P=0.652）.二组手术均顺利完成,无术中输血者及严重术中并发症者,腹腔镜手术无中转,腹腔镜组失血量（5.9±5.0）ml明显少于开放于术组（26.7±13.2）ml（P＜0.01）,手术时间（98.5 min±23.2 min和118.8min±22.8min）的差异无统计学意义（P=0.053）.二组患儿术后平均症状评分均接近0分（P=0.899）,但腹腔镜组术后住院时间（4.3±1.3）d和术后进食固体食物时间（7.7±4.1）d显著短于开放手术组（7.8±1.3）d和（17.4±11.1）d,（P＜0.01和P=0.014）.经过（45.1±26.6）个月的随访,食管最大横径差（9.9mm±7.9mm和6.6 mm±5.6mm）和食管下端最窄横径差（5.5 mm±4.8mm和5.2 mm±2.3 mm）两项指标在2组间比较的差异无统计学意义（P=0.275,P=0.830）,2组中所有病例均无吞咽困难复发、无胃食管反流等并发症者.结论 对儿童贲门失弛缓症,腹腔镜Heller手术能达到与传统开放经腹Heller手术相同的长期疗效,且术后近期疗效明显优于开放手术.Objective To compare the efficacy between laparoscopic and open Heller＇s operation for pediatric esophageal achalasia. Methods A total of 22 children with esophageal achalasia underwent transabdominal surgical treatment in the authors＇ institutions from October 2002 to October 2009. According to operative approach, all cases were divided into two groups, open surgery group （n= 12） and laparoscopic group （n = 10）. Modified Heller esophagomyotomy associated with a partial fundoplication was performed for each patient. Perioperative data including symptom scoring, duration of surgery, blood loss, conversion to open surgery, intraoperative mucosal tear, morbidity, length of hospital stay and solid feeding resumption time were analyzed. Based on postoperative symptom scoring and radiologic diameter of the esophagus, long term outcomes were evaluated between these 2 groups. Results No significant difference was noted in illness course （27. 3 ± 23. 7 vs. 30. 7 ± 36. 3,P = 0. 796） or preoperative symptom scoring （5. 7 ± 2. 4 vs. 6. 1 ± 1. 9, P = 0. 652） between 2 groups.Both procedures were performed without severe intraoperative complications or blood transfusion. No conversion to open surgery was applied in the laparoscopic group. Both group had similar operative time [（118. 8 ± 22. 8）min vs. （98. 5 ± 23. 2）min, P = 0. 053], while less blood loss was noted in the laparoscopic group than that in the open surgery group [5.9 ± 5. 0） ml vs. （26. 7 ± 13. 2） ml, P＜0. 01]. The postoperative symptom scoring of both groups were close to 0 （P = 0. 899）, but mean postoperative length of hospital stay and resumption of solid feedings in the laparoscopic group （4. 3 d ± 1.3 d and 7. 7 d ± 4. 1 d） were significantly less than those in the open group （7. 8 d ± 1.3 d and 17. 1 d ± 11. 1 d,P＜00. 01 and P = 0. 014, respectively）. There was no recurrent dysphasia or postoperative gastroesophageal reflux in any patient during follow-up period [（45. 1 ± 26. 6） months]. No s

关 键 词：食管失弛症 腹腔镜外科手术 

分 类 号：R686[医药卫生—骨科学]