腹腔镜Heller肌切开联合Dor胃底折叠术治疗贲门失弛缓症22例临床分析

Clinical analyses of 22 cases of laparoscopic Heller myotomy and Dor fundoplication for treating achalasia

目的分析腹腔镜Heller肌切开联合Dor胃底折叠术治疗贲门失弛缓症的临床疗效。方法回顾性分析2010年1月至2022年8月新疆维吾尔自治区人民医院微创外科、疝和腹壁疝外科收治的22例贲门失弛缓症病人的临床资料,均行腹腔镜Heller肌切开联合Dor胃底折叠术治疗。分析手术时间、术中出血量、并发症及术后复发情况,并进行随访观察。结果22例病人均通过高分辨率食管测压明确诊断为贲门失弛缓症,其中芝加哥分类Ⅰ型3例,Ⅱ型17例,Ⅲ型2例,均顺利在胃镜引导下完成腹腔镜手术(双镜联合),无中转开放手术病例,手术时间为75.8(55~120)min,术中出血18.5(5~30)mL,未发生食管瘘,术后住院时间为3.5(2~7)d。术后随访3个月至8年,中位随访时间为4.6年,无复发病例。结论胃镜直视下行腹腔镜Heller肌切开联合胃底折叠术治疗贲门失弛缓症安全可行。

Objective To investigate the efficacy of laparoscopic Heller myotomy and Dor fundoplication for Achalasia patients.Methods The clinical data of 22 Achalasia patients were retrospectively analyzed who were diagnosed and treated during January 2010 to August 2022 in the People’s Hospital of Xinjiang Uyghur Autonomous Region.Operative time,introperative bleeding,complications,and recurrence rate were observed.Results All 22 patients were confirmed as achalasia with high resolution manometry.According to Chicago classification,3 patients were TypeⅠ,17 patients were typeⅡ,2 patients were typeⅢachalasia,and all patients successfully performed laparoscopic Heller myotomy and Dor fundoplication under endoscope navigation.The average operative time were 75.8(55-120)min,the average blood loss were 18.5(5-30)mL,and no occurrence of gastrointestinal fistula.The mean postoperative hospital stay were 3.48(2-7)d.The mean postoperative follow-up was 4.6 years(3 months to 8 years),and no recurrence was observed during the follow-up.Conclusion Laparoscopic Heller myotomy and Dor fundoplication under endoscopic navigation are an effective and safe surgical procedures of minimal invasion for Achalasia.