腹腔镜下Heller肌切开联合Dor胃底折叠术治疗贲门失弛缓症的临床体会(附11例报告)

Clinical outcome of laparoscopic Heller myotomy and Dor fundoplication for cardia achalasia:with a report of 11 cases

目的:探讨腹腔镜下Heller肌切开+Dor胃底折叠术治疗贲门失弛缓症的临床疗效及贲门失弛缓症的最新研究进展。方法:回顾分析2015年10月至2017年12月收治的11例贲门失弛缓症患者的临床资料,并追踪随访术后临床短期疗效,比较手术前后患者Eckardt得分、食管扩张直径,术后36 h采用视觉模拟评分法评价疼痛程度。结果:手术均获成功,1例出现食管黏膜破损,延迟出院。手术时间平均(154.2±40.7)min,出血量平均(17.1±9.5)ml,术后36 h疼痛评分平均(2.0±0.5)分,术后平均住院(5.7±2.8)d;术后仍吞咽困难1例,Eckardt评分为4分。手术前后食管扩张直径平均(4.4±1.2)cm与(3.0±0.8)cm,Eckardt评分平均(4.7±0.9)分与(2.2±0.9)分;手术前后差异有统计学意义(P<0.05)。结论:腹腔镜下Heller肌切开联合Dor胃底折叠术治疗贲门失弛缓症疗效满意,是理想的治疗方案之一。

Objective： To explore the clinical effects of laparoscopic Heller myotomy and Dor fundoplication for treatment of achalasia,and to discuss the latest research progress about the treatment of achalasia. Methods： The clinical data of 11 patients with achalasia admitted from Oct.2015 to Dec.2017 were retrospectively analyzed.11 patients underwent laparoscopic Heller myotomy combined with Dor fundoplication and were followed up for clinical short-term therapeutic effect,the preoperative and postoperative Eckardt scores and esophageal dilation diameters were compared.Pain degree at postoperative 36 h was evaluated by visual analogue scale. Results： All the 11 operations were successfully completed.During the operation,only one case of the esophageal mucosa was damaged and the discharge was delayed.The mean operation time was（ 154.2±40.7） min,the average blood loss was（ 17.1±9.5） ml,the pain score was（ 2.0±0.5） min at 36 h after the operation,and the average postoperative hospital stay was（ 5. 7 ± 2. 8） d. 1 patient suffered from postoperative dysphagia and the Eckardt score was 4 points. Before and after operation,the esophageal dilatation diameter was（ 4. 4 ±1.2） cm and（ 3.0±0.8） cm,respectively; the Eckardt scores were（ 4.7± 0.9） and（ 2.2± 0. 9） with statistical difference（ P〈 0. 05）.Conclusions： Laparoscopic Heller myotomy combined with Dor fundoplication is a satisfactory and ideal treatment for achalasia.