胃镜辅助腹腔镜改良Heller手术治疗贲门失弛缓症

Gastroscopy-assisted laparoscopic modified Heller operation for patients with achalasia

目的:探讨胃镜辅助下腹腔镜改良Heller手术治疗贲门失弛缓症的疗效及并发症。方法:为35例贲门失弛缓症患者行胃镜辅助腹腔镜改良Heller术,观察术后症状的解除及并发症情况,随访最少1年,观察术后短期疗效。结果:手术时间60~200 min,出血量10~200 ml。术后住院4~7 d,无一例中转开腹,术后症状均有明显改善。2例患者术中损伤食管黏膜,镜下修补后未出现食管瘘。术后2个月复查钡餐,均未见梗阻,食管扩张较前改善;复查24 h食管pH值基本正常,pH<4的时间占(1.4%±2.7%),pH监测的患者中5例(14.3%)提示有病理性酸反流,仅1例患者有轻度症状,保守治疗后症状缓解。术前食管测压显示食管下括约肌压力升高,术后2个月复查压力明显下降。随访1年以上,1例于术后5个月出现食管梗阻,扩张治疗后好转。结论:胃镜辅助腹腔镜改良Heller手术治疗贲门失弛缓症效果明显,并发症少,可在临床上推广应用。

Objective：To investigate the effects and complications of the gastroscopy-assisted laparoscopic modified Heller operation for the treatment of achalasia of cardia.Methods：Retrospective analysis was conducted on the clinical data of 35 patients with achalasia of cardia who received gastroscopy-assisted laparoscopic modified Heller operation.The alleviation of postoperative symptoms and complications were observed.All patients were followed up for at least one year to observe the short-term effects.Results：The operation time was 60-200 min.Blood loss during operation was 10-200 ml.The time of hospitalization was 4-7 d.No conversion to open surgery was required.After operation all patients achieved significant alleviation of symptom.Two patients suffered from intraoperative esophageal mucosa injury and underwent laparoscopic repair,no esophagostoma was found after operation.All patients were reexamined by barium meal in two months after operation,no obstruction was found and esophageal expansion was improved.Most patients had normal 24 h pH in follow-up.The time of pH less than 4 accounted for（1.4% ± 2.7%）.The 24 h pH indicated that 5 patients（14.3%）suffered from pathological acid reflux,however,only one patient had mild symptom and relieved after conservative therapy.Pressure of the lower esophageal sphincter increased before operation and decreased significantly in 2 months after the surgery.After more than 1 year,only one patient had esophageal obstruction recurrence and improved after gastroscopic expanding treatment.Conclusions：The results of gastroscopy-assisted laparoscopic modified Heller operation for achalasia of cardia is significant,the procedure can be promoted and applied in clinical practice with limited complications.