经腹Heller手术治疗贲门失弛缓症的远期疗效(附112例报告)

Long-term results of modified Heller myotomy for achalasia by abdominal approach: 112 cases experience

目的 评价经腹Heller手术治疗贲门失弛缓症的远期疗效。方法 回顾分析1973年6月至2 0 0 3年6月,112例经腹Heller手术治疗贲门失弛缓症病例资料。其中行单纯Heller手术19例,Heller附加抗反流术式93例(Lortat Jacob术式6 0例,Toupet术式2 0例,Dor术式13例)。结果 96例获得随访资料,随访1～10年。效果优良者79例,改善者14例,无效3例。17例发生反流性食管炎,单纯Heller手术组术后反流发生率明显高于Heller附加抗反流术(P <0 0 5 ) ;胃壁肌层切开长度大于2cm组术后反流发生率高于长度小于2cm组(P <0 0 5 )。结论 经腹Heller手术治疗贲门失弛缓症远期疗效满意;Heller手术不加抗反流术以及胃壁肌层切开长度大于2cm者术后易发生反流性食管炎。

Objective To evaluate the long-term results of modified Heller operation for achalasia through abdominal approach. Methods 112 patients with achalasia undergone Heller operation through abdominal approach were studied retrospectively. Results 19 cases underwent modified Heller operation only whereas 93 patients received anti-reflux procedure sirnultaneously. Lortat-Jacob technique was performed in 60 cases, Tonpet in 20 and Dor in 13. Conclusion Heller myotomy for achalasia through abdominal approach can provide good long-term results. Reflux is likely to happen for the group of modified Heller operation without anti-reflux procedure and the incision of gastric parietal muscle wall is longer than 2 cm.