腹腔镜Heller-Dor手术治疗贲门失弛缓症的临床分析

Clinical analysis on 53 cases with achalasia of cardia treated by laparoscopic Heller-Dor surgery

目的 探讨腹腔镜Heller-Dor手术治疗贲门失弛缓症的安全性及有效性.方法 回顾性分析2013年1月至2023年12月在天津市南开医院接受腹腔镜Heller-Dor手术53例贲门失弛缓症患者的临床资料,包括手术时间、术中出血量、术后住院时间及短期并发症情况,并对患者进行术后12个月随访,进行术前、术后贲门失弛缓症状评分(Eckardt评分和Gerd-Q评分)比较.结果 53例患者手术均获成功,平均手术时间(124±22)min,术中平均出血(15±5)ml,术后平均住院时间(4.2±1.3)d.与术前相比,术后患者的Eckardt评分和Gerd-Q评分均较术前改善(均P<0.05).术后53例患者均获得随访,平均随访12个月.全组患者症状均明显好转,其中症状消失48例,改善5例.术后11个月发生胃食管反流1例.结论 腹腔镜Heller-Dor手术除了能有效改善贲门失弛缓症的症状外,还能有效防止术后的胃食管反流症状,并且手术操作较简单,创伤小,并发症少.

Objective To explore the safety and effectiveness of laparoscopic Heller-Dor surgery in the treatment of achalasia.Methods The clinical data of 53 patients with achalasia who underwent laparoscopic Heller-Dor surgery from Jan 2013 to Dec 2023 were retrospectively analyzed,including operation time,intraoperative blood loss,postoperative hospitalization,and short-term complications.Patients were followed up for 6 to 12 months after surgery.The preoperative and postoperative achalasia symptom scores(Eckardt score,Gerd-Q score)were compared.Results All operations were successful,with an average operation time of(124±22)min,an average intraoperative blood loss of(15±5)ml,and an average postoperative hospital stay of(4.2±1.3)d.Compared with those before the operation,the Eckardt score and Gerd-Q score of the patients after the operation were improved compared with that before surgery(all P<0.05).The average postoperative follow-up was 12 months in all 53 cases.One patient with end-stage achalasia developed mild dysphagia 11 months after surgery,and the symptoms of the remaining 52 cases improved significantly.Among them,symptoms disappeared in 48 cases and improved in 5 cases.Conclusions Laparoscopic Heller-Dor surgery can not only effectively improve the symptoms of achalasia,but also effectively prevent postoperative gastroesophageal reflux symptoms.The operation is simple,less invasive,and has fewer complications.