目的：评价经腹 Heller手术附加Dor部分胃底折叠术治疗贲门失弛缓症的疗效，比较不同胃壁肌层切开长度对术后疗效的影响。方法回顾性分析1983年12月-2010年1月间经腹Heller手术附加部分胃底折叠术治疗的56例贲门失弛缓症患者的临床资料。患者按照胃壁肌层的切开长度分为A组（胃壁肌层切开长度＜2 cm组）和B组（胃壁肌层长度≥2 cm组），比较两组患者手术治疗后的症状评分、胃食管返流情况及食管末端直径变化。结果56例随访6个月～5年，无围手术期死亡和严重并发症。术后6～18个月评分优良者53例，症状改善者3例。术后5例出现反流症状。两组的疗效评分和胃食管返流发生率的差异无统计学意义。结论经腹Heller手术附加Dor术治疗贲门失弛缓症时，胃壁肌层切开长度可以＞2 cm。减少经腹 Heller手术后胃食管反流的关键在于附加合适的抗反流措施。%Objective To evaluate the curative effect of trans-abdominal Heller with Dor fundoplication for achalasia and compare the results of modified Heller operation with Dor anti-reflux procedure for achalasia through abdominal approach .Methods 56 patients were divided into two groups according to the length of the gastric parietal muscle incision .The incisions were shorter than 2 cm in 31 cases and longer than 2 cm in 25 cases .The symptom scores ,the diameter of lower esophagus and the gastro esophageal reflux were evaluated retrospectively .Results Follow-up visites were conducted from 6 months to 5 years and there was no death during the perioperative period or severe complication .53 cases got excellent or good results and the symptoms of patients in 3 cases were improved .Postoperative reflux occurred in 5 cases .There was no statistically significant difference in the symptom scores ,the diameter of lower esophagus and the gastro esophageal reflux between two groups . Conclusion Heller myotomy with Dor fundoplication through abdominal approach can provide good results for achalasia .The incision of gastric parietal muscle can be longer than 2 cm and Heller myotomy with Dor fundoplication is effective to ameliorate postopera-tive reflux symptoms .
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