摘要
目的 探讨双镜联合下Heller肌切开加改良Dor胃底折叠术治疗贲门失弛缓症的疗效。
方法 回顾性分析2015年1月至2016年12月，吉林大学第二医院收治的11例贲门失弛缓症患者的临床资料。全组患者均在双镜联合下行Heller肌切开加改良Dor胃底折叠术：在食管前壁切开并剥离食管肌层，使食管黏膜完全膨出；将胃底向右折叠180°覆盖被暴露的食管黏膜外，将右侧膈肌脚与胃底缝合固定3~5针。疗效判定采用Eckardt评分标准：术后Eckardt评分≤3分即为治疗有效，否则为治疗无效。
结果 11例患者男7例，女4例，平均年龄47（33~71）岁。6例患者曾接受内科保守治疗。11例患者均顺利在双镜联合下完成Heller肌切开加改良Dor胃底折叠术，无中转开腹或死亡病例。手术时间85（78~137）min，术中出血量15（5~35）ml，术中未发生上消化道穿孔，全组患者术后平均住院7（6~9）d。患者术后食管下端括约肌压力较术前明显降低[（5.31 ± 6.23）mmHg比（35.72 ± 17.13）mmHg，P 〈 0.05]，Eckardt评分亦明显下降（0.53 ± 0.56比6.17 ± 1.17，P 〈 0.05），差异均有统计学意义。随访时间2~23月，1例患者术后6月出现反酸症状，1例患者17月出现吞咽困难症状，分别给予质子泵抑制剂和胃动力药物，以及球囊扩张治疗后缓解。结论双镜联合下Heller肌切开加改良Dor胃底折叠术治疗贲门失弛缓症创伤小，恢复快，疗效确切。
Objective To investigate the efficacy of combined laparoscopic-endoscopic lower esophageal sphincterotomy and modified Dor fundoplication for cardiochalasia patients.
Methods Clinical data of 11 cardiochalasia patients who underwent combined laparoscopic-endoscopic lower esophageal sphincterotomy and modified Dor fundoplication by the same medical team from January 2015 to December 2016 at The Second Hospital of Jilin University were retrospectively analyzed. The procedure was as follows： an incision was made in the anterior wall of esophagus and dissection of esophageal muscular layer was performed, then the bulged esophageal mucosa was covered by the fundus after 180° fold to the right （fundoplication） , finally the gastric fundus was joined to the right diaphragmatic foot by 3 to 5 knotted suture. The efficacy was judged by the Eckardt scoring standard： the postoperative Eckardt score ≤ 3 points indicated effectiveness, otherwise the treatment was invalid.Results Combined laparoscopic-endoscopic lower esophageal sphincterotomy and modified Dor fundoplication was completed successfully in all the 11 patients without any subsequent laparotomy and death. The mean operative time was 85 （78 to 137） min, blood loss was 15 （5 to 35） ml, and no upper digestive tract perforation occurred. The mean postoperative hospital stay was 7.0 （6 to 9） d.After the operation, the pressure of lower esophageal sphincter decreased significantly compared to that before operation[ （5.31 ± 6.23） mmHg vs. （35.72 ± 17.13） mmHg, P 〈 0.05], and the Eckardt score decreased significantly as well （0.53 ± 0.56 vs. 6.17 ± 1.17, P 〈 0.05） . During the follow-up of 2 to 23 months, there was no postoperative mortality. One case experienced mild gastroesophageal reflux 6 months after operation, and another patient had recurrent dysphagia 17 months after operation, who both were improved after receiving proton pump inhibitors or gastric dynamic drugs, and balloon dilation.
Conclusion Combined laparoscopic-endoscopic lower esophageal sphincterotomy and modified Dor fundoplication is an effective and safe surgical procedure for cardiochalasia with minimal invasion and fast recovery.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2017年第8期880-883,共4页
Chinese Journal of Gastrointestinal Surgery
