食管胃底大口径内瘘加胃折叠术治疗贲门失驰缓症

Large diameter esophagogastric internal fistula combined with fundoplication for treatment of achalasia

目的探讨食管胃结合部大口径内瘘加胃折叠术与改良Heller术治疗贲门失弛缓症的临床效果差异。方法选取2008年6月至2014年3月在我院确诊为贲门失弛缓症的患者18例,将行食管胃结合部大口径内瘘加胃折叠术者8例作为观察组,采用改良Heller术的患者10例作为对照组;比较2组患者手术疗效及并发症情况。结果 18例患者均成功完成既定手术治疗,术后3个月造影显示造影剂顺利通过食管贲门及吻合口进入胃腔。观察组术后12个月总体有效率为100%,对照组12个月总体有效率为60%,2组比较差异有统计学意义(P=0.014)。观察组并发症发生率低于对照组,差异有统计学意义(P=0.026)。结论食管胃结合部大口径内瘘加胃折叠术,安全性更高,可达到根治效果。

Objective To explore the clinical the efficacy of large diameter esophagogastric internal fistula combined with fundoplication and modified Heller surgery for treatment of achalasia. Methods From June 2008 to March 2014,18 patients diagnosed as achalasia were se- lected into this suty, and they were divided into the observation group （8 cases） and the control group （ 10 cases）. Patients of the observation group were received large diameter esophagogastric internal fistula combined with fundoplication while patients of the control group received modified Heller surgery. Compared the surgical curative effect and complications between the two groups. Results All the 18 patients suc- cessfully completed the arranged surgical treatment. The imaging examination 3 months after the operation showed that the contrast agent suc- cessfully passed through the esophagus, cardia and the anastomosis, and then went into the gastric lumen. The total effective rate was 100% in the observation group 12 months after operation, while it was 60% in the control group, and the difference between the two groups was statisti- cally significant （ P = 0. 014）. The incidence of complications in the observation group was lower than that of the control group, the difference was statistically significant （P = 0. 026 ）. Conclusion Large diameter esophagogastric internal fistula combined with fundoplication for treat- ment of achalasia is safer, and there is a possibiltiy to cure the achalasia.