经腹Heller手术加绕食管后方胃底部分折叠治疗贲门失弛缓症

Treatment of achalasia of cardia by transabdominal cardiomyotomy plus posteroesophageal partial gastric fundoplication

目的 探讨采用经腹贲门肌层切开 (Heller)加绕食管后方胃底部分折叠治疗贲门失弛缓症的疗效。方法 回顾性总结 48例贲门失弛缓症经腹Heller手术加绕食管后方胃底部分折叠治疗的近期及远期效果。结果 全组病例手术后恢复顺利 ,吞咽困难症状缓解 ,无手术并发症。 3 8例进行了食管动力学监测 ,术前末端食管括约肌压力 (LESP)为 ( 2 1 4 8±5 3 6)mmHg ,术后LESP为 ( 16 4 5± 4 12 )mmHg ,两者经统计学处理 (t检验 )无显著差异 (P >0 0 5 ) ,2 5例进行了术后 2 4hpH值监测 ,DeMeester记分均在正常范围。近期手术优良率 10 0 %。 3 1例进行了 13～ 15 6个月的随访。平均随访时间 75个月。随访病人均能正常生活和工作 ,3例有反流症状 ,其中 1例 2 4hpH值监测反流次数超过 5 0次。远期手术优良率 90 3 2 %。结论 经腹Heller手术加绕食管后方胃底部分折叠治疗贲门失弛缓症疗效满意 。

Objective To evaluate the therapeutic efficacy of transabdominal cardiomyotomy plus posteroesphageal partial gastric fundoplication to treat achalasia of cardia. Methods From May 1988 to February 2000, 48 patients with achalasia of cardia underwent this procedure. The patients were analyzed by using pre and post operative symptom, barium meal, esophageal manometry and 24 hour esophageal pH monitoring. Results All patients recovered smoothly and the relief of dysphagia was achieved in all patients. There were no postoperative complication or deaths. In 38 (38/48) patients, the lower esophageal sphincter pressure (LESP) before and after operation was 21.48±5.36 mmHg and 16.45±4.12 mmHg ( P >0.05), respectively. Twenty five (25/48) postoperative patients underwent 24 hour esophageal pH monitoring and their DeMeester scores were in normal ranges. Thirty one (31/48) patients were followed up for 13 to 156 months. All the patients followed up could live and work normally. Three patients presented postoperative reflux symptom. The long term satisfactory operation rate was 90.32%. Conclusion Transabdminal cardiomyotomy plus posteroesophageal partial gastric fundoplication is a safe and effective procedure for the treatment of achalasia of cardia.