贲门失弛缓症术式探讨

EVALUATION OF SURGICAL STYLE FOR ACHALASIA OF THE CARDIA

目的 探讨治疗贲门失弛缓症的理想术式。方法 回顾分析66例贲门失弛缓症患者的治疗效果,评估手术方式与其疗效的关系。结果 单纯Heller肌层切开术15例,Heller手术附加Belsev MarkⅣ胃底折叠术17例,自行设计的改良Heller手术附加胃底折叠术34例。全组随访3年以上,失访3例按无效计算,疗效优、良者占91.2％(60/66)。单纯Heller手术病例术后复发3例(3/15,20.0％),发生反流性食管炎4例(4/15,26.7％);Heller手术附加Belsey MarkⅣ胃底折叠术发生反流性食管炎2例(2/17,11.8％),膈裂孔疝1例(1/17,5.9％);而改良Heller手术附加胃底折叠术无复发及反流。全组无手术死亡及其他并发症。结论 改良式Heller手术加胃底折叠术式治疗贲门失弛缓症疗效较好。

Objective To investigate the ideal style for achalasia of the cardial. Methods 3 different styles of surgical operation were performed in 66 cases with achalsia of the cardial from March 1986 to September 1997. Of which Heller' s esophagomyotomy were undergone in 15 cases, Heller- Belsey MarklV in 17 cases, the modified Heller- Fundoplication in 34 cases. Results The efficacy of the various surgical approaches was good, of which the percent is 91. 2% . There were acklasia relapsed in 3 cases (3/15, 20. 0%) and 4 cases developed reflux oesophagitis (4/15, 26. 7%) after Heller's esophagomyotomy, 2 cases got reflux oesophagitis (2/17, 11.8% ) and 1 cases got diaphragmatic hernia (1/17, 5.9% ) after Heller - Belsey MarklV . Neither recurrence nor reflux oesophagitis occurred in cases who underwent modified Heller- Fundoplication. Conclusion The modified Heller- Fundoplication is an ideal surgical approach for achalasia of the cardial.