Objective To compare the outcomes of laparoscopic modified Heller myotomy combined with Dor vs. Toupet fundoplication for achalasia. Methods Forty-three patients undergoing laparoscopic Dor/Toupet fundoplication following modified Heller myotomy were selected. Symptomatic GERD scores were compared between the two groups; Basal LES pressure,residual LES pressure,and amplitude distal contractions were observed preoperatively and postoperatively in all patients. Follow-up data were collected at 12 months, including symptomatic evaluation and 24 h pH testing. Results Postoperative data of esophageal manometry were improved in all patients compared with the preoperative status(P<0.05), but they were similar between the Dor and Toupet groups (P > 0.05) ; DeMeester scores and 24 h pH after 12 months were improved significantly compared with preoperative status in all patients (P <0.05). In the Toupet group the recovery of symptoms including dysphagia, heartburn, and chest pain was better than the Dor group( P <0. 05) , while other symptoms had no statistically significant differences. Conclusion Laparoscopic modified Heller myotomy provides significant improvement in dysphagia and regurgitation symptoms in achalasia patients regardless of the type of partial fundoplication. The Toupet approach has more advantages over Dor approach in terms of symptom after 12 months and 24 h pH test results.%目的 探讨两种抗返流胃底折叠术(Dor/Toupet)联合腹腔镜改良Heller肌切开术治疗贲门失弛缓症中临床效果的差别.方法 选择经腹腔镜行改良Heller+ Dor术及改良Heller+Toupet术患者43例,比较其GERD症状敏感度分数,检测手术前后食管静息LES压力、残余LES压力、食管远端收缩期压力指标；术后随访12个月,比较患者各项症状改善情况及食管末端24 h pH值.结果 两组患者术后食管测压较术前明显改善,差异有统计学意义(P＜0.05),Toupet组和Dor组术后组间差异无统计学意义(P＞0.05)；患者术后1年相关症状改善情况、食管pH监测各项指标动态发现较术前明显改善(P＜0.05),组间患者症状改善比较,Toupet组吞咽困难、胸痛及烧心症状改善情况优于Dor组(P＜0.05),而恶心/呕吐、胀气/暖气、咳嗽/声嘶、哮喘等症状差异无统计学意义(P＞0.05).术后1年Toupet组病理性返流次数、最长返流时间、pH ＜4.0时间、DeMeester积分均低于Dor组(P＜0.05).结论 两种抗返流胃底折叠术(Dor/Toupet)联合腔镜Heller肌切开术治疗贲门失弛缓症均能明显改善患者症状,减少胃酸返流次数及时间,同时Toupet术式组在1年后症状改善及pH监测相关指标较Dor术式组更具优势.
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