【摘要】 目的比较贲门失弛缓症的外科治疗方法,探讨并发症的防治。方法以术前辅助检查为依据,23例患者中经腹行手术治疗共16例,经胸行手术治疗共7例。其中共有8例行DOR术式,3例行幽门成形术。术后禁食为1~5d,全组病例随访3个月~10年。结果23例患者术后的临床症状均改善,3例单纯行肥厚肌层切开术患者出现食管反流,1例经胸行手术治疗患者出现膈疝。结论贲门失弛缓症患者术前须行内镜检查以明确诊断,术式的选择以术前辅助检查为依据。经腹手术损伤小,术后肺部并发症少、恢复快,避免术后肌纤维瘢痕粘连是手术成功的关键。DOR术式能有效预防反流的发生,术后加用质子泵抑制剂能有效缓解反流性食管炎。更多还原

【Abstract】 Objective To investigate the surgical therapies for esophageal achalasia and the measure to prevent from complications. Methods Twenty-three cases with esophageal achalasia underwent Surgical treatment based on the preoperative assistant inspection. Sixteen were by laparotomy and 7 cases by thoracotomy. There were 8 cases were treated with the DOR anti-reflux procedure and 3 cases were with disconnection of pyloric sphincter. Two had mucosa breach and had to be mended. All the patients fasted for 1 to 5 days after operation. The follow-up was 3 to 120 months. Results The clinical symptoms were improved in all cases. The regurgitation was found in 3 cases underwent esophagomyotomy only, and midriff colic was found in 1 case operated by thoracotomy. Conclusions Esophagoscopy is a necessary diagnostic approach before operation. The choice of surgical intervention depends on preoperative inspection. Operations by laparotomy have fewer injuries and complications. Avoiding postoperative scar conglutination is the key of a successful operation. DOR fundoplication can effectively avoid the reflux. PPI can effectively prevent from the reflux esophagitis.更多还原