腹腔镜下Heller肌切开加Dor胃底折叠术治疗贲门失弛缓症的临床体会

Clinical experience of laparoscopic Heller myotomy and Dor fundoplication for achalasia

目的:探讨腹腔镜下Heller肌切开加Dor胃底折叠术治疗贲门失迟缓症的治疗效果以及折叠术对术后返流症状的预防作用。方法:回顾性分析我院自2010年12月至2012年7月行腹腔镜下Heller肌切开加Dor胃底折叠术治疗贲门失迟缓症的患者资料,随访患者术后吞咽困难、反酸等症状,总结临床体会。结果:10例贲门失弛缓症患者顺利完成腹腔镜下Heller肌切开术并加做胃底折叠术,患者平均住院天数(13.2±4.1)d,术后住院天数(7.1±2.6)d,术中出血(5.2±1.9)mL,手术时间(78.5±26.8)min;术后无1人死亡,随访患者1例6个月时出现反酸症状,1例1年后出现吞咽困难症状。结论:腹腔镜下heller肌切开加Dor胃底折叠术应作为治疗贲门失迟缓症推荐方式。

Objective：To assess the efficacy of laparoscopic Heller Myotomy for achalasia and the prevention of Dor fundoplication for postoperative gastroesophageal reflux. Methods： The baseline data of patients diagnosed with achalasia from December 2012 to July 2012 was retrospectively reviewed. These included the collected outcomes of postoperative dysphagia, gastroesophageal reflux and con- cludions of the clinical experience. Results： A total of 10 consecutive patients received iaparoscopic Heller Myotomy and Dor fundopli- cation. The average hospital stay time was 13.2 （± 4.1 ） days, and the postoperative hospital stay time was 7.1 （ ± 2.6） days. Intr- aoperative blood loss was 5.2 （ ± 1.9） mL. Operative time was 78.5 （ ± 26.8） minutes. In the follow-up, there was no postoperative mortality. One of them experienced mild gastroesophageal reflux six months after operation, and another patient had recurrent dysphagia 12 months after operation. Conclusion： Laparoscopic Heller myotomy and Dor fundoplication should be recommended as the optional method for achalasia.