胃镜辅助胸腔镜改良Heller手术治疗贲门失弛缓症

Gastroscopy-assisted thoracoscopic modified heller operation for treatment of achalasia of cardia

摘要:

目的 探讨胃镜辅助胸腔镜改良Heller手术治疗贲门失弛缓症的效果及优势。方法 对33例症状明显且保守治疗无效的的贲门失弛缓症患者采用胃镜辅助胸腔镜改良Heller手术治疗，观察术后食道梗阻解除的效果及并发症的发生情况，并术后随访半年，观察疗效。结果 33例贲门失弛缓症患者术后食道梗阻症状均有不同程度改善。其中1例由于胸腔粘连严重，改为开放手术；4例并发食管黏膜损伤，胸腔镜下修补食管。1例患者出现食管胸膜瘘，保守治疗1个月后瘘管愈合。1例患者术后出现胃食管返流，保守治疗后症状缓解。随访半年，仅1例于术后3个月再次出现食道梗阻，予扩张治疗后好转。结论 胃镜辅助胸腔镜改良Heller手术治疗贲门失弛缓症手术效果明显，手术操作简单易行，并发症少，可在临床上推广应用。

Abstract:

Objective To observe the effects and benefits of the gastroscopy-assisted thoracoscopic modified Heller operation for the treatment of achalasia of cardia. Methods Retrospective analysis was conducted on the clinical data of 33 cases in our hospital. The surgical approach was gastroscopy-assisted thoracoscopic modified Heller operation. The intraoperative and postoperative effect and complications were observed. All patients were followed up for six months. Results After operation 33 achalasia patients' symptom of obstruction is alleviated. 1 case changed to open operation because of severe adhesion; 4 cases esophageal mucosal were injured and need to be repair assisted by thoracoscope. 1 case had esophagopleural fistula after operation and was cured by conservative treatment in one month. 1 case had gastroesophageal reflux symptoms after operation and relief symptoms after conservative treatment. All patients were follow-up more than six months, only 1 patient recured eating obstruction in 3 months after operation, and was cured by gastroscopic expanding treatment. Conclusions The results of gastroscopy-assisted thoracoscopic modified Heller operation to patients with Achalasia is significant. The operation is easy to perform and the complications is less, it can be promoted and applied in clinical practice.