经腹行Heller加改良Dor手术治疗贲门失弛症的临床疗效观察  

Clinical outcome of transabdominally Heller-Dor operation for achalasia

作　　者：韩洪利[1] 张逊[1] 脱磊[1] 卢喜科[1] 孙大强[1] 徐医军[1] 

机构地区：[1]天津市胸科医院胸外科,300051

出　　处：《中华胸心血管外科杂志》2011年第3期141-143,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 评价经腹行Heller术加改良Dor术治疗贲门失弛症的疗效.方法 经腹行Heller加改良Dor手术治疗贲门失弛症病人33例,其中18例术前及术后均行食管测压检查及24 h食管pH监测,对术前及术后食管下括约肌静息压（LESP）及24 h内食管反流次数、最长反流时间（min）、pH＜4.0时间（min）、pH＜4.0时间百分比（%）等指标进行统计学分析.结果 术后1例仍有吞咽困难,其余32 例症状明显好转.术后1个月复查食管测压检查及24 h食管pH监测,LESP值较术前明显下降（P＜0.001）.24 h反流次数、最长反流时间、pH＜4.0时间、pH＜4.0时间百分比等指标较术前均有下降,差异均有统计学意义（P＜0.05）.随访30例（90.9%,30/33例）,其中症状消失22例（73.3%,22/30例）,改善8例（26.7%,8/30例）;术前经24 h食管下端pH监测证实其中3例（16.7%,3/18例）存在不同程度的胃食管反流,术后随访均无反流性食管炎发生.结论 经腹行Heller加改良Dor手术除能明显改善贲门失弛症的症状外,还能有效防止术后可能带来的胃食管反流,且手术操作较简单,创伤小,并发症少.Objective To evaluate the effect of curing achalasia by transabdominally Heller-Dor operation. Methods To summarize 33 cases of achalasia treated by transabdominally Heller-Dor procedure and visit them postoperatvely. 18 patients receive pre- and post-operativemanometry and 24-hour-pH monitoring. The parameters including reflux frequency 、the longest lasting-time of reflux 、the total time（min） of pH 〈4.0 and the percentage（ % ） of time of pH 〈4.0 were recorded and compared using statistical mothods. Results Symptom was significantly improved in 32 patients after surgery, while 1 patient remained dysphasia as pre-operative. The LESP, the reflux frequency、the longest lasting-time of reflux 、the total time（min） of pH 〈 4.0 and the percentage （ % ） of time of pH 〈 4.0 also declined after operations （ P 〈 0. 05 ）. 30 patients were followed up,22 （73.3% ,22/30） were cured and 8 had mild sypmtom. Reflux did not detected in 3 cases（ 16.7% ,3/18 ） with preoperative reflux. Conclusion Transabdominally Heller-Dor operation could dramadically alleviate the symptoms of patients with achalasia, moreover, it could especially prevent the postoperative-reflux, and with the advantages of simple operations, little traumas.

关 键 词：贲门 食管失弛症 食管成形术 

分 类 号：R655.4[医药卫生—外科学]