中国实用外科杂志

中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (08): 684-686.

• 论著 • 上一篇    下一篇

腹腔镜联合胃镜微创治疗贲门失弛缓症26例分析

赵宏志，秦鸣放，王    庆，勾承月，李    宁   

  1. 天津市南开医院 天津市微创外科中心，天津300100
  • 出版日期:2010-08-01 发布日期:2010-08-02

  • Online:2010-08-01 Published:2010-08-02

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摘要：

目的    探讨采用腹腔镜联合胃镜微创手术治疗贲门失弛缓症的可行性及临床价值。方法    2005年12月至2009年3月，天津市南开医院对26例贲门失弛缓症病人实施腹腔镜Heller括约肌切开加Dor胃底折叠术，术中联合胃镜进行定位、检查，对围手术期相关指标进行分析，并随访观察治疗效果。结果    26例均完成腹腔镜手术，无中转开腹病例，术后无严重并发症。1例术中食管黏膜破损，经胃镜证实后行腹腔镜下修补术，随访观察4～42个月无吞咽困难，1例术后1年内出现轻度胃食管反流及胸骨后疼痛症状，术后3个月复查食管测压、胃镜、上消化道造影提示均基本恢复正常。结论    腹腔镜治疗贲门失弛缓症具有手术创伤小、恢复快、疗效可靠的特点，术中联合胃镜操作可提高手术安全性，减少并发症的发生。

关键词: 贲门失弛缓症, 腹腔镜, 胃镜, 微创治疗

Abstract:

Laparoscopy combined with esophagogastroscopy in the minimally invasive treatment of achalasia of cardia: an analysis of 26 cases        ZHAO Hong-zhi, QIN Ming-fang, WANG Qing, et al. Center of Tianjin Minimally Invasive Surgery, Nankai Hospital, Tianjin 300100，China
Corresponding author: ZHAO Hong-zhi, E-mail: tjzhhzh@sina.com
Abstract    Objective    To investigate the feasibility and clinical value of laparoscopy combined with esophagogastroscopy in the minimally invasive treatment of achalasia of cardia. Methods    From December 2005 to March 2009, 26 patients with achalasia of cardia were performed combined laparoscopic and esophagogastroscopic surgery at Nankai Hospital of Tianjin. The combined surgery comprised of laparoscopic Heller myotomy with Dor fundoplication and intraoperative gastroscopic guidance and examination. Perioperative clinical outcome data of all patients were collected and analyzed prospectively. Results    All laparoscopic surgeries were accomplished successfully. No conversion to open surgery or severe complications were noted in the study. Perforation of esophageal mucosa occurred in 1 patient，which discovered by esophagogastroscopy during laparoscopic operation. The patient was received laparoscopic neoplasty immediately. With postoperative follow-up of 4 to 42 months, none of the patients appeared dysphagia or vomiting. There was one patient who appeared mild regurgitation and chest pain in the first year after operation. After 3 months of operation，postoperative assessment consisted of endoscopic, radiologic, manometric and pH metric studies showed a satisfactory result. Conclusion    Laparoscopy operation should be the feasible procedure to treat the typical esophagic achalasia with the advantages of little trauma, quick recovery and reliable effect. Combined with intraoperative gastroscopic guidance and examination, it can improve the security and decrease the complication during laparoscopy operation.

Key words: achalasia of cardia, laparoscopy, esophagogastroscopy, minimally invasive treatment