腹腔镜在治疗胃食管反流病和贲门失弛缓症中的应用

Application of laparoscopy in treatment of gastroesophageal reflux and cardiac achalasia

目的探讨腹腔镜手术在治疗胃食管反流病和贲门失弛缓症中的临床应用价值。方法经腹腔镜手术治疗胃食管反流病和贲门失弛缓症30例，其中胃食管反流病21例，行食管裂孔疝修补加Toupet胃底折叠17例，单纯Toupet式胃底折叠4例；贲门失弛缓症9例，行Heller肌切开加Dor胃底折叠术。结果本组无中转开腹。手术时间70—300min，平均110min。术中出血量10～200ml，平均15ml。住院时间6～16d。29例临床症状基本消失，术后食管测酸、测压均恢复正常范围。3例胃食管反流病患者术后存在轻度的反酸、烧心症状，1例贲门失弛缓症患者又出现间歇性吞咽困难，均经内科短期治疗后缓解。结论腹腔镜手术治疗胃食管反流病和贲门失弛缓症具有显露好、创伤小、恢复快、疗效好等优点，值得推广应用。

Objective To study the clinical application of laparoscopic surgery in gastroesophageal reflux and cardiac achaiasia. Methods From May 2002 to June 2007,30 patients with gastroesophageal reflux or cardiac achalasia underwent laparoscopic surgery,of which laparoscopic hiatal herniorraphy and Toupet＇ s fundoplication were performed in 17 cases, single laparoscopic Toupet＇ s fundoplication in 4 cases and laparoscopic Heller＇ s myotomy and Dor＇ s fundoplication in 9 eases. Results No conversion to open surgery was required in this study. The operative duration ranged from 70 to 300 min（ mean 110 min）. The intraoperative blood loss was 10 - 200 ml（ mean 15 ml）. The hospital stay was 6 - 16 d（ mean 8 d）. All the patients were normal in esophageal manometry and ambulatory pH studies. Follow - up for 3 months - 2 years in all the patients showed the patients were asymptomatic except that light symptoms remained in four cases. Conclusions Laparoscopic operation for the treatment of gastroesophageal reflux and cardiac achalasia has such advantages as clear operative field, trivial trauma, short recovery period and good effects.