开胸和胸腔镜下改良Heller手术治疗贲门失弛缓症的临床分析  

作　　者：孟小鹏[1] 郑国平[1] 张六伢[1] 陈维[1] 

机构地区：[1]浙江大学第一附属医院绍兴分院胸外科,312000

出　　处：《浙江临床医学》2015年第10期1690-1691,共2页Zhejiang Clinical Medical Journal

摘　　要：目的 比较传统开胸及胸腔镜下改良Heller手术治疗贲门失弛缓症的术中及术后结果.方法 39例贲门失弛缓症患者接受改良Heller手术.根据手术方式分成2组.其中开胸Heller手术组（开胸组）16例,胸腔镜Heller手术组（胸腔镜组）23例,比较术前和术后食管直径、食管下段括约肌压力（LESP）、食管末端pH值,以及两组手术时间、出血量、术后住院时间、住院费用、术后并发症及手术有效率.结果 39例均手术成功,无食管穿孔等严重术后并发症.随访1年,开胸组及胸腔镜组有效率分别为93.8％和91.3％.两组术后食管直径、LESP、食管末端pH值均较术前明显改善.胸腔镜组在出血量和术后住院时间明显低于开胸组（p＜0.05）.两组手术时间和住院费用比较差异无统计学意义（P＞0.05）.结论 改良Heller手术治疗贲门失弛缓症安全、有效.胸腔镜创伤小,住院时间短,值得有条件的医院推广.Objective To report and compare the outcomes of conventional and thoracoscopic Heller myotomy for achalasia. Methods Thirty- nine patients, diagnosed with achalasia, were enrolled and underwent curative Heller myotomy. The patients were categorized based on different approaches as the following two groups： group of conventional Heller myotomy （ conventional thoracotomy group ） , group of thoracoscopic Heller myotomy （ thoracoscope group ） . Clinical data was summarized and analyzed. Result Neither failed operation nor esophageal perforation were reported in this study. The effective rate from the above two groups was 93.8% and 91.3% after 1 year. There were improved evidence after operation among the two groups in terms of diameter of esophageal, the low esophageal sphincter pressure （ LESP ） and average pH of distal esophagus. The intraoperative bleeding volume and postoperative length of stay in hospital in thoracoscope group were better than those in conventional thoracotomy group. There were no statistical difference was found among the two groups in terms of operative time and the hospitalization expenses. Conclusions Heller myotomy is safe and feasible in treatment of achalasia. Thoracoscopic Heller myotomy is lesser wound and shorter length of stay in hospital than conventional Heller myotomy.

关 键 词：胸腔镜 贲门失弛缓症 HELLER手术 

分 类 号：R656.61[医药卫生—外科学]