经腹Heller术附加Dor部分胃底折叠术治疗贲门失弛缓症的疗效观察

Observation of curative effect of trans-abdominal Heller with Dor fundoplication for achalasia

目的评价经腹Heller手术附加Dor部分胃底折叠术治疗贲门失弛缓症的疗效，比较不同胃壁肌层切开长度对术后疗效的影响。方法回顾性分析1983年12月-2010年1月间经腹Heller手术附加部分胃底折卺术治疗的56例贲门失弛缓症患者的临床资料。患者按照胃壁肌层的切开长度分为A组（胃壁肌层切开长度〈2cm组）和B组（胃壁肌层长度≥2cm组），比较两组患者手术治疗后的症状评分、胃食管返流情况及食管末端直径变化。结果56例随访6个月～5年，无同手术期死亡和严重并发症。术后6～18个月评分优良者53例，症状改善者3例。术后5例m现反流症状。两组的疗效评分和胃食管返流发生率的差异无统计学意义。结论经腹Heller手术附加Dor术治疗贲门失弛缓症时，胃壁肌层切开长度可以〉2cm。减少经腹Heller手术后胃食管反流的关键在于附加合适的抗反流措施。

Objective To evaluate the curative effect of trans-abdominal Heller with Dor fundoplication for achalasia and compare the results of modified Heller operation with Dor anti-reflux procedure for achalasia through abdominal approach. Methods 56 patients were divided into two groups according to the length of the gastric parietal muscle incision. The incisions were shorter than 2 cm in 31 cases and longer than 2 cm in 25 cases. The symptom scores, the diameter of lower esophagus and the gastro esophageal reflux were evaluated retrospectively. Results Follow-up visites were conducted from 6 months to 5 years and there was no death during the perioperative period or severe complication. 5g cases got excellent or good results and the symptoms of patients in 3 eases were improved. Postoperative reflux occurred in 5 cases. There was no statistically significant difference in the symptom scores, the diameter of lower esophagus and the gastro esophageal reflux between two groups. Conclusion Heller myotomy with Dor fundoplication through abdominal approach can provide good results for achalasia. The incision of gastric parietal muscle can be longer than 2 cm and Heller myotomy with Dor fundoplication is effective to ameliorate postoperarive reflux symptoms.