开胸与胸腔镜下改良Heller手术治疗贲门失弛缓症的疗效比较

Comparison of conventional and thoracoscopic Heller myotomy for esophageal achalasia

目的比较传统开胸及胸腔镜下改良Heller手术治疗贲门失弛缓症的疗效。方法收集39例行改良Heller手术的贲门失弛缓症患者,其中开胸手术(开胸组)16例,胸腔镜下手术(胸腔镜组)23例,比较两组患者术前和术后食管直径、食管下段括约肌压力(LESP)、食管末端pH值,以及手术时间、术中出血量、术后住院时间、住院费用、术后并发症发生情况及手术有效率等。结果39例均手术成功,无术后食管破裂等严重并发症。随访1年,开胸组及胸腔镜组有效率分别为93.8%和91.3%。两组患者术后食管直径、LESP、食管末端pH值均较术前明显改善(P<0,05)。胸腔镜组术中出血量和术后住院时间明显少于开胸组(均P<0.05)。两组手术时间和住院费用比较差异无统计学意义(均P>0 05)。两组患者术后有效率和肺部感染发生率比较差异无统计学意义(均P>0.05)。胸腔镜组术后食管反流发生率明显低于开胸组(P<0.05)。结论改良Heller手术治疗贲门失弛缓症安全、有效,胸腔镜下手术创伤小,住院时间短,值得有条件的医院推广。

Objective To compare the efficacy of conventional and thoracoscopic Hel er myotomy for esophageal sachalasia. Methods Thirty- nine patients with esophageal achalasia underwent curative Hel er myotomy, including 16 pa-tients were treated by conventional Hel er myotomy （conventional group） and 23 patients by thoracoscopic Hel er myotomy （thoracoscopy group）. Clinical data was reviewed and compared between two groups. Results Al operations were suc-cessful and no esophageal perforation were reported in both groups. The effective rates of conventional and thoracoscopy groups were 93.8% and 91.3%, respectively. There were significant improvement in esophageal diameter,low esophageal sphincter pressure （LESP） and average pH of distal esophagus after treatment in both groups （P〈0.05）. The intraoperative bleeding volume and postoperative length of hospital stay in thoracoscope group were less than those in conventional group （P〈0.05）. There were no statistical difference was found among the two groups in terms of operative time and the hospitalization expenses（P〉0.05）. There were no significant difference in effective rate and pulmonary infection between two groups（P〉0.05）. The rate of esophageal reflux in thoracoscope group was lower than that in conventional group （P〈0.05）. Conclusion Hel er myotomy is safe and feasible in treatment of esophageal achalasia. Thoracoscopic Hel er myotomy has less invasive-ness and shorter length of hospital stay than conventional Hel er myotomy.