腹腔镜手术处理胃食管结合部疾病

Laparoscopic surgery in the treatment of disease of the gastroesophageal junction

目的:探讨腹腔镜下行食管裂孔疝修补术、顽固性十二指肠球部溃疡迷走神经切断术和贲门失弛缓症Heller肌层切开术的疗效和安全性。方法:从1995年11月至2007年9月,在腹腔镜下共行食管裂孔疝修补37例、顽固性十二指肠球部溃疡迷走神经切断术26例和贲门失弛缓症Heller肌层切开术4例。结果:手术时间1.0～4.5 h,平均2.5 h;24～72 h后开始进流质。无术后并发症,术后平均6(4～7)d出院。结论:腹腔镜手术治疗食管裂孔疝、顽固性十二指肠球部溃疡和贲门失弛缓症,具有疗效确定、创伤小和恢复快的优点;腹腔镜手术很适用于处理胃食管结合部病变。

Objective To evaluate the efficacy and safety of laparoscopic surgery in the treatment of paraesophageal hernia, laparoscopic vagotomy for intractable duodenal ulcer, and laparoscopic Heller＇s myotomy for achalasia. Methods During the period from Nov.1995 to Sept.2007, a total of 67 patients underwent laparoscopic procedures for diseases of the gastroesophageal junction,including 37 cases of paraesophageal hernia repair, 26 cases of laparoscopic vagotomy for intractable duodenal ulcer and 4 cases of laparoscopic Heller myotomy for achalasia. Results Laparoscopic surgery was successfully performed in all patients, not a single case was converted to open surgery. The average operation time was 2.5 hours（range from 1.0 to 4.5 hours）, postoperative oral feeding was resumed after 24 to 72 hours, and no postoperative complication was observed. The median postoperative hospital stay was 6 days（range from 4 to 7 days）. Conclusions Laparoscopic surgery is an effective and safe surgical procedure in the treatment of diseases of the gastroesophageal junction.