胸腔镜联合胃镜微创治疗贲门失弛缓症的效果观察

Observation of endoscopy combined thoracoscopy treating esophageal achalasia

目的探析胸腔镜联合胃镜微创治疗贲门失弛缓症的效果。方法回顾性分析贵州省人民医院2009年3月至2012年5月收治的行胸腔镜Heller术30例贲门失迟缓症患者（观察组）的临床资料，术中联合胃镜检查、定位，选取同期治疗的30例患者（作为对照组）行胃镜下环行肌切开术手术治疗，分析围手术期相关的临床指标以及随访疗效。结果观察组30例患者均顺利成功完成胸腔镜手术，术后均未出现严重的并发症。1例患者在手术过程中由于食管黏膜破损，经胃镜证实之后行修补术，随访期间未见吞咽困难。2例患者在术后1年之内轻度胃食管反流以及胸骨后疼痛症状，在术后3个月内复查均恢复到正常水平。术后3个月随访，观察组食管测压显示静息压为（23.5±5.7）mmHg（1 mmHg=0.133 kPa），对照组为（37.3±7.8）mmHg；观察组残留压为（3.5±2.6）mmHg，对照组为（7.7±3.5）mmHg；观察组松弛率为（89±10）%，对照组为（76±7）%，2组比较差异有统计学意义（P〈0.05）。结论胸腔镜联合胃镜治疗贲门失弛缓症微创、恢复期短、疗效显著，安全性较高，可有效地减少或者避免并发症的发生。

ObjectiveTo analyze the effect of endoscopy combined minimally invasive thoracoscopy on esophageal achalasia. MethodsThirty cases with esophageal achalasia in Guizhou Province People′s Hospital were retrospectively analyzed and they were treated with thoracoscope Heller surgery; additional 30 cases during the same period were chosen as control group treated with POEM surgery. Perioperative clinical indicators and the curative effect of followup were analyzed. Results Thirty patients were successfully treated by thoracic surgery without serious complications. One patient was given laparoscopic repair due to esophageal mucosa damage during the operation. No dysphagia happened during followup. Two patients had mild gastroesophageal reflux and retrosternal pain one year after operation. The patients restored to normal level after 3 months. Postoperative followup was 3 months. Esophageal pressure in observation group was （23.5±5.7）mmHg,（37.3±7.8）mmHg in the control group;residual pressure in observation group were （3.5±2.6）mmHg and was （7.7±3.5）mmHg in the control group; relaxation rate in observation group was （89±10）%, （76±7）% in the control group; the difference was statistically significant between two groups （P〈0.05）. ConclusionsEndoscopy combined minimally invasive thoracoscopy in treatment of esophageal achalasia has a short recovery period and can effectively reduce or avoid complications.