胸腔镜辅助Heller肌层切开术治疗贲门失弛缓症

Thoracoscopy-assisted Heller myotomy for treatment of achalasia

目的总结胸腔镜辅助Heller肌层切开术治疗贲门失弛缓症的经验。方法2001￣2003年间5例贲门失弛缓症患者行胸腔镜辅助Heller肌层切开术。其手术要点为纵行切开由贲门上6cm至贲门下1cm胃底、食管肌层,直达黏膜下层,同时确保黏膜完整。结果男3例,女2例,年龄16～65岁,平均(43.7±22.6)岁,病史2～32a。1例为外院手术治疗后复发,其余患者术前未接受治疗。手术2.0～4.5h,平均(2.8±1.4)h。胸腔引流管置管2～7d,胸腔引流110～460mL。住院4～21d。所有患者均未发生食管漏,无手术死亡。随访3个月以上,吞咽困难均缓解良好。结论胸腔镜辅助Heller肌层切开术治疗贲门失弛缓症具有安全、有效、微创的优点。

[Objective] To summarize the experience of thoracoscopy-assisted Heller myotomy for the treatment of achalasia, [Methods] From 2001 to 2003, 5 patients underwent thoracoscopy-assisted Heller myotomy. The keypoint of the operation was to dissect the esophagogastric muscularis until beath the submucosa, from 6 cm upper to 1 cm lower of the cardia longitudinally, while preserving mucosa integrity. [Results] 2 male and 3 female cases were included, aging 16-65 years （mean 43.7±22.6 years）, with 2-32 years illness history. All patients received no treatments previously, except for one who recun＇ed postoperatively from other hospital. Mean operation duration was （2.8± 1.4） hours （range 2.0-4.5 hours）. Chest tube retaining time was 2-7 days, with drainage volume 110-460 mL. Hospitalization was 4-21 days. No patients suffered esophageal leakage nor operative death. Dysphagia did not recur after 3 months followup. [Conclusion] Thoracoscopy-assisted Heller myotomy is safe, effective and mini-invasive for the treatment of achalasia.