摘要
目的探讨经胸小切口食管肌层切开术治疗贲门失弛缓症的方法和疗效。方法回顾性分析68例贲门失弛缓症患者经胸部小切口进行食管下段肌层切开手术进行治疗的疗效。左胸第7肋间切口6-8cm,食管下段肌层切开上方超过狭窄1 cm,下方切口至胃壁肌层1 cm。全组均未行抗反流手术。结果平均手术时间45 min,术后平均住院时间11 d,无手术死亡。1例损伤食管黏膜予以修补,其余无任何并发症。黏膜完整者术后第2天开始进食,行黏膜修补者术后3 d进食。术后随访,66例患者吞咽困难症状改善明显;2例患者吞咽困难症状改善不明显,经胃镜扩张后缓解。全部病例无明显胃食管反流症状。26例行食管pH监测无病理性反流,与术前DeMeesrer评分比较,差异有统计学意义（P〈0.05）。结论经胸小切口食管肌层切开术创伤小、恢复快、并发症少,合理掌握胃食管连接部的肌层切开范围可有效防止术后胃食管反流。
Objective To review the experience of transthoracic Heller myotomy for achalasia with a small incision. Methods The outcome of 68 patients with achalasia undergone transthoracic Heller myotomy with a small incision was analyzed. The length of the incisions was 6--8 cm. The range of the incision was 1 cm over the stricture part of the esophagus,and 0. 5--1.0 cm below the gastroesophageal junction. Antireflux procedure was not carried out on all the patients. Results The mean operating time and hospital stay were 45 minutes and 11 days, respectively. One patient died of esophageal mucosa rupture combined with multiple infections,and two patients with esophageal mucosa rupture got repaired. The diet was resumed after the second postoperative day for the patients without complications, and at the third postoperative day for the patients undergone esophageal mucosa rupture. After one to three years＇ follow up, the symptom of dysphagia in 66 patients disa- ppeared. And 2 patients still has dysphagia. No severe pathological reflux was detected in all the patients. Conclusion Transthoraeic Heller myotomy has the advantages of small incision, quick recovery and few complications. Proper management of the incision range of muscle layer below the gastroesophageal junction may prevent gastroesophageal reflux.
出处
《海军总医院学报》
2009年第2期73-74,共2页
Journal of Naval General Hospital of PLA
