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目的探讨采用腹腔镜联合胃镜微创手术治疗贲门失弛缓症的可行性及临床价值。方法2005年12月至2009年3月,天津市南开医院对26例贲门失弛缓症病人实施腹腔镜Heller括约肌切开加Dor胃底折叠术,术中联合胃镜进行定位、检查,对围手术期相关指标进行分析,并随访观察治疗效果。结果26例均完成腹腔镜手术,无中转开腹病例,术后无严重并发症。1例术中食管黏膜破损,经胃镜证实后行腹腔镜下修补术,随访观察4～42个月无吞咽困难,1例术后1年内出现轻度胃食管反流及胸骨后疼痛症状,术后3个月复查食管测压、胃镜、上消化道造影提示均基本恢复正常。结论腹腔镜治疗贲门失弛缓症具有手术创伤小、恢复快、疗效可靠的特点,术中联合胃镜操作可提高手术安全性,减少并发症的发生。
Objective To investigate the feasibility and clinical value of laparoscopy combined with minimally invasive gastroscopic surgery for achalasia. Methods From December 2005 to March 2009, 26 patients with cardiac achalasia underwent laparoscopic Heller sphincterotomy and Dor fundoplication in Nankai Hospital of Tianjin from December 2005 to March 2009. The patients underwent gastroscopic surgery for positioning and examination during operation. Related indicators were analyzed and followed up to observe the effect of treatment. Results 26 cases were completed laparoscopic surgery, no transfer laparotomy cases, no serious complications. 1 case of intraoperative esophageal mucosal damage confirmed by gastroscope after laparoscopic repair, follow-up observation of 4 to 42 months without dysphagia, 1 case of mild gastroesophageal reflux within 1 year and post-sternal pain symptoms After 3 months of esophageal manometry, endoscopy, upper gastrointestinal imaging tips were returned to normal. Conclusions Laparoscopic treatment of achalasia has the advantages of small trauma, quick recovery and reliable curative effect. Combined operation of endoscopy and gastroscope can improve the operation safety and reduce the occurrence of complications.