免气腹辅助3D腹腔镜改良Heller肌切开联合Dor胃底折叠治疗贲门失弛缓症

摘要

Objective To investigate the clinical value of gasless 3D laparoscopic modified Heller myotomy combined with Dor fundoplication for the treatment of achalasia . Methods A retrospective analysis on 32 cases of achalasia treated with gasless 3D laparoscopic gastric cardia and esophageal myotomy with Dor fundoplication ( anterior 180 degrees of gastric fundus folding suture ) in our hospital between July 2013 and November 2015 was made . Results The gasless laparoscopic surgery were successfully performed in all the 32 cases.The average operation time was (71.6 ±36.8) min, the average intraoperative bleeding was (23.6 ± 18.4) ml, and the average length of stay was (8.2 ±2.6) days.No complications such as esophageal leakage or death cases were found.The patients were followed up for 6 -34 months (mean, 15.3 months).The Eckardt scores were grade Ⅰ in 20 cases (62.5%), grade Ⅱin 9 cases (28.1%), and grade Ⅲin 3 cases (9.4%).The surgery was effective in 29 cases(90.6%) and failed in 3 cases (9.4%).At the 6 months after surgery, the maximal transverse diameter of the esophagus was significantly improved as compared with preoperation [(31.1 ±5.2) mm vs.(45.3 ±8.0) mm, t =11.064, P=0.000] in 23 cases. Conclusion Gasless laparoscopic modified Heller myotomy combined with Dor fundoplication should be recommended as an optional method for achalasia with satisfactory efficacy .%目的：探讨免气腹辅助3D腹腔镜改良 Heller 肌切开联合 Dor 胃底折叠治疗贲门失弛缓症的临床价值。方法2013年7月～2015年11月对32例贲门失弛缓症行免气腹辅助3D腹腔镜下贲门食管肌层切开，联合Dor胃底折叠术（前部180°胃底折叠缝合术）。结果32例均成功完成免气腹腹腔镜手术，手术时间（71．6±36．8） min，术中出血量（23．6±18．4）ml，住院时间（8．2±2．6）d，无食管漏等并发症及死亡。32例术后随访6～34个月，平均15．3月，Eckardt评分Ⅰ级20例（62．5％），Ⅱ级9例（28．1％），Ⅲ级3例（9．4％）；手术有效29例（90．6％），失败3例（9．4％）。23例术后6个月复查食管吞钡造影，食管最大横径（31．1±5．2）mm，较术前（45．3±8．0）mm明显改善（t＝11．064，P＝0．000）。结论免气腹辅助3D腹腔镜改良Heller联合Dor胃底折叠术治疗贲门失弛缓症疗效满意。