腹腔镜Heller括约肌切开联合Dor胃底折叠术治疗贲门失弛缓症临床效果

摘要

目的 探讨腹腔镜Heller括约肌切开联合Dor胃底折叠术治疗贲门失弛缓症的临床效果及安全性.方法 选取2009年1月—2015年12月我院收治的行腹腔镜Heller括约肌切开联合Dor胃底折叠术的贲门失弛缓症198例,分别于术前1 d、术后1个月行吞咽困难症状评分、生活质量评分及体重评估,观察食管高分辨率测压、上消化道造影、胃镜检查变化,记录手术并发症发生情况.结果 所有患者均顺利完成手术,31例失访,167例获得随访,随访6~84(65.3±10.6)个月,术中及术后均无明显并发症发生.术后吞咽困难多数明显缓解,出现反流、胃灼热12例,吞咽慢6例,腹胀5例,缓解不明显3例.42例术后6~9个月复查,食管高分辨率测压均无食管下括约肌(LES)基础压升高,食管体部静息压均低于胃内压;胃镜检查示LES进镜均无阻力;上消化道造影示均无蠕动波,18例扩张程度较术前减轻.术前及术后吞咽困难评分、生活质量评分、体重比较差异均有统计学意义(P<0.05).结论 腹腔镜Heller括约肌切开联合Dor胃底折叠术治疗贲门失弛缓症安全性高,并发症较少,能明显改善患者吞咽困难,提高生活质量.%Objective To investigate clinical effect and safety of laparoscopic Heller sphincterotomy combined with Dor fundoplication in treatment of cardiochalasia. Methods A total of 198 cardiochalasia patients undergoing laparoscopic Heller sphincterotomy combined with Dor fundoplication during January 2009 and December 2015 were recruited in this study. Dysphagia symptoms score, score of life quality and body weight were evaluated on 1 d before operation and in 1 month after operation, and changes of high-resolution pressure measurement, upper digestive tract angiography and gastroscope examina-tion were also observed, and incidence rate of postoperative complications were recorded. Results The surgeries were suc-cessful for all patients, and 31 patients were lost follow-up, and 167 patients were followed up for 6-84 ( 65. 3 ± 10. 6 ) months, and there were no obvious complications during and after surgeries. After surgeries, dysphagia was obviously re-lieved, and there were 12 patients with reflux and heartburn, 6 patients with slowly hypopharyngeal food, 5 patients with ab-dominal distension and 3 patients with little relief. With postoperative 6-9 months review for 42 patients, oesophageal high-res-olution pressure measurement showed no elevated lower esophageal sphincter ( LES) basic pressure, and resting pressure of e-sophageal body was lower than that of gastric pressure;gastroscopy showed that there was no resistance when mirror was ente-ring the LES;Upper gastroenterography showed that there was no peristaltic wave, and postoperative extension degrees in 18 patients were decreased compared with those before surgeries. There were significantly differences in dysphagia score, life quality score and body weight before and after surgeries (P<0. 05). Conclusion Laparoscopic Heller sphincterotomy com-bined with Dor fundoplication in treatment of cardiochalasia is safe with few complications, and it can improve dysphagia symptom and improve quality of life.