改良Heller手术附加胃底折叠术治疗贲门失弛缓症55例疗效观察

Therapeutic effect of improved Heller's myotomy and fundoplication for achalasta in 55 cases.

目的总结改良Heller手术附加胃底折叠术治疗贲门失弛缓症的临床经验。方法1990年1月至2006年11月,对55例贲门失弛缓症施行改良Heller手术附加胃底折叠术。手术经左开胸,纵行切开食管肌层6～10 cm,使黏膜膨出达到食管周径的1/2～2/3,最后将胃底上提覆盖于食管贲门肌肉切开处,并用细丝线间断缝合固定在食管肌层切缘上。结果55例患者治愈39例(78%),好转11例(22%),总有效率100%,全组无死亡病例。50例获得随访,随访率90.9%,随访期1～11年。结论改良Heller手术附加胃底折叠术,简单易行,治疗效果较好,尤其是抗返流效果满意。

Objective To summarize the experiences of improved Heller＇s myotomy and fundoplication for achalasia. Methods 55 patients with achalasia received Heller＇s myotomy and fundoplication from January 1990 to November 2006. Surgical esophagomyotomy was performed through a left thoracotomy. A short 6 to 10cm myotomy was completed on the distal esophagus. The mucosa was dissected free from the muscularis over 1/2-2/3 of the esophageal circumference, allowing its protrusion between the cut muscle margins which was interrupted sutured on the margin of tun/ca muscularis oesophagi. Results There was no operative mortality. 50 patients were followed up 1-11 years postoperatively. The completely cured rate was 78%. The improved rate was 22%. The overall effective rate was 100%. Conclusion Improved Heller＇s myotomy and fundoplication for achalasia is a safe, simple and effective procedure, especially offers satisfactory control of reflux symptoms.