摘要
目的:探索三种腹腔镜胃底折叠术治疗胃食管反流病及Heller肌切开术治疗贲门失弛缓症的安全性与可行性。方法:1995年12月至2004年9月,经腹腔镜手术治疗了胃食管反流病人45例和贲门失弛缓病人5例。术前常规行胃镜与上消化道钡餐检查者50例,加行食管测酸、测压检查者39例。腹腔镜单纯胃底折叠术10例(Nissen式1例,Toupet式9例);腹腔镜食管裂孔疝修补加胃底折叠术35例(Nissen式11例,Toupet式24例)。Heller肌切开术加Dor胃底折叠术5例。结果:全组病人的平均手术时间为120(60～360)min,术中平均出血量15(10～100)ml,术后日平均引流量20(10～100)ml,平均住院7(5～12)d。其中前10例使用电刀者平均用时210(180～360)min,中转开腹1例;后40例使用超声刀者平均用时100(60～180)min。术中脾被膜划破出血2例,12例Nissen式胃底折叠术后有1例出现吞咽困难,1月后缓解。42例获随访的病人中40例不再需要服药。其中5例Heller肌切开术Dor胃底折叠术病人术后第2天即可顺畅进食,且无反流。结论:与传统的经胸或经腹手术相比,腹腔镜抗反流手术治疗胃食管反流病和Heller肌切开贲门失弛缓症的病人具有心肺干扰小、麻醉难度低、创伤小、痛苦轻、并发症少、住院时间短、康复快、疗效好等突出优点。经过不断改进手术设计和加强训练可使?
Objective To investigate the safety and efficiency of laparoscopic surgery in treating patients with gastroesophageal reflux disease and achalasia. Methods Between December 1995 and September 2004, 50 patients with gastroesophageal reflux disease or achalasia were submitted to laparoscopic surgery. All the patients had upper GI barium series and esophagogastroscopy to rule out esophageal carcinoma and short esophagus. Esophageal manometry and 24 hours ambulatory pH studies were performed in 39 patients. The operations performed were: fundoplication only, 10 cases (Nissen 1, Toupet 9); laparoscopic hiatal herniorraphy in combination, 35 cases (Nissen 11, Toupet 24); modified Heller's myotomy with Dor's fundoplication, 5 cases. Results The average operating time was 120 minutes (60-360), the average operative blood loss was 15(10-100)ml, postoperative drainage was 20(10-100)ml in average , postoperative hospitalization 7(5-12)days. In the earlier 10 cases using electrocautery, the average operating time was 210(180-360)minutes, with 1 case converted to open surgery. In the group of later 40 cases using harmonic scalpel, the average operating time was 100(60-180)minutes. Two patients had tear of the spleen during operation, 1 had postoperative dysphagia which disappeared 1 month later. Among the 42 patients followed-up, 40 did not need any medication. Five patients with cardiac achalasia could swallow easily without symptoms of reflux after the Heller-Dor operation. Conclusions Laparoscopic antireflux surgery gives less disturbance to the heart and lung during operation, being minimally invasive, causes less pain and less complications postoperatively, needs shorter hospitalization and enjoys faster convalescence. In term of the surgical efficiency, Toupet's fundoplication has been superior to Nissen's. Dor's fundoplication is effective against reflux for patients undergoing Heller's myotomy.
出处
《外科理论与实践》
2004年第6期458-460,共3页
Journal of Surgery Concepts & Practice
