摘要
1982年至1989年应用胃粘膜瓣式贲门成形术治疗贲门失弛缓症30例,效果满意,无返流性食管炎发生,其手术方法:(1)左第7肋间开胸,解剖食管下段,切开膈肌、食管及贲门半周游离,食管下段左侧纵形全层切开5cm(食管狭窄段消失为止),胃壁切开1.5cm,计6.5cm。(2)将胃创缘与胃底浆肌层先做结节缝合,创缘与胃底的针距两端是4cm,中间2cm,缝成向腔内突出的粘膜瓣。(3)食管切开不直接缝合,创缘顶点,两侧与胃壁先缝5针,然后做结节缝合,加宽食管内径,胃壁上吊1cm缝合于食管肌层做半周胃底折叠复盖,在无张力下缝合胃壁与膈肌。(4)制作的胃粘膜瓣是下垂的,食物通过时开放,通常胃内压高于食管内压,不吞咽食物时胃粘膜瓣处于关闭状态,附加胃底折叠更加强胃粘膜瓣作用,从而控制了返流。 本方法可扩大食管下段贲门部内径,解除梗阻,又用活瓣式贲门取代了括约肌式贲门,收到食管通畅无返流的效果,防止了反流性食管炎发生。
From 1982 to 1989, gastric mucosal valviform cardioplasty was performed in 30 patients with achalasia. The follow-up results were satisfactory without regurgitant esophagitis.The method of operation: (1) The operation was done through the left 7th intercostal space under gerneral anethesia. The diaphragm was incised and lower segment of esophagus was freed for a distance of 10cm. A longitudinal incision 5cm in length was made in the distal esophagus extending to the gastric cardia for a distance of 1.5cm. (2) Interrupted stitches were placed at the cut edge of the gastric cardia and a valve like mucosal flap was formed. (3) The esqphageal cut edge was sutured to the gastric cut edge to widen the esophageal lumen, and the stomach wall was super imposed on the suture line for a distance of 1cm. Suture the diaphragm to the stomach wall without tension. (4) The formed gastric mucosal valve was popinting distally, so that it opened when food passed. As the pressure inside the stomach was usually higher than the esophagus, the valve was always in a closed condition. The additional cardiac fold prevented against regurgitation.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
1993年第6期433-435,共3页
Medical Journal of Chinese People's Liberation Army
关键词
胃粘膜瓣
贲门成形术
贲门失弛缓症
Cardioplasty with stomach mucosa flap
Cardiochalasia
Sugical treatment
