【摘要】 目的探讨腹腔镜胃镜联合手术治疗贲门失弛缓症的临床价值。方法2003年10月~2006年4月,采用腹腔镜胃镜联合Heller肌切开Dor胃底折叠治疗贲门失弛缓症25例。结果手术均获成功,手术时间60~240 m in,平均107m in。术中出血量5~60 m l,平均22 m l。术中4例分破食管或胃黏膜。术后8 h下床活动,1~3 d(平均1.5 d)排气、拔胃管进流食。术后7 d复查食管测压食管下括约肌(lower esophageal sph incter,LES)功能压均降至正常;24 h食管pH监测3例酸反流指数高于正常,但无症状。术后8 d复查上消化道钡餐,扩张的食管最大横径平均缩小18 mm(8~26 mm)。术后8~11 d出院,平均8.5 d。25例随访1~30个月,平均5.4月,术前症状均消失。2例因进食不当出现间断吞咽困难。结论腹腔镜胃镜联合手术治疗贲门失弛缓症具有定位准确、创伤小、痛苦轻、疗效好等突出优点,同时可以提高手术质量,减少并发症。更多还原

【Abstract】 Objective To investigate the value of laparoscopy combined with esophagogastroscopy in the treatment of achalasia of the cardia. Methods Twenty-five patients with achalasia of the cardia between October 2003 and April 2006 in this department underwent the HellerDor operation under laparoscopy combined with esophagogastroscopy.Results A1l the operations were successfully accomplished.The operating time was 60~240 min(mean,107 min) and the intraoperative blood loss,5~60 ml(mean,22 ml).Intraoperative mucosal perforation was encountered in 4 patients.All the patients got out of bed for activities at 8 hours after operation,with first passage of flatus,removal of the gastric tube,and liquid diet intake at 1~3 days after operation(mean,1.5 days).The esophageal manometry showed the lower esophageal sphincter(LES) pressure had decreased to normal levels at 7 days after operation.The 24-hour ambulatory pH studies showed a high reflex index in 3 patients,but without symptoms.Upper gastrointestinal barium swallow showed the dilated esophagus had a 8~26 mm(mean,18 mm) decrease in diameter at 8 days after operation.The length of postoperative hospitalization was 8~11 days(mean,8.5 days).Follow-up for 1~30 months(mean,5.4 months) in all the patients showed 23 patients were asymptomatic and 2 had intermittent dysphagia.Conclusions Heller-Dor operation under laparoscopy combined with esophagogastroscopy has advantages of precise positioning,little invasion,less pain,and good effects,increasing the quality of operation as well as decreasing the incidence of complications.更多还原