腹腔镜手术治疗贲门失弛缓症5例报道

目的探讨腹腔镜微创手术治疗贲门失弛缓症的应用价值。方法 2007年11月至2009年12月期间,中国医科大学附属盛京医院微创外科对5例贲门失弛缓症患者实施腹腔镜改良Heller手术并胃底折叠术。结果手术过程顺利,手术时间120~165 min,平均139 min;术中失血50~200 ml,平均88 ml;术后第1天进食,吞咽困难症状消失,无手术相关并发症。5例患者均痊愈出院。术后随访8~31个月,平均19个月,无症状复发或出现返流症状。结论腹腔镜手术治疗贲门失弛缓症安全、效果良好,值得进一步推广。     

腹腔镜联合胃镜微创治疗贲门失弛缓症26例分析

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。     

腹腔镜Heller括约肌切开术治疗贲门失弛缓症

目的：探讨采用腹腔镜微创手术治疗贲门失弛缓症的可行性及临床效果。方法：对5例患者在术中行胃镜定位、监视下行腹腔镜Heller括约肌切开术治疗。结果：4例手术顺利,1例患者由于粘连严重,术中分破远端食管,经胃镜证实后即行腹腔镜下修补术,术后1d,4例症状明显改善,1例术后1周吞咽困难症状逐渐改善。随访5～17个月,均未再发生吞咽困难、返流、胸骨后疼痛等症状。结论：腹腔镜Heller括约肌切开术治疗贲门失弛缓症创伤小、恢复快,并可作为内科治疗失败后的补救治疗。     

手术治疗贲门失弛缓症36例

目的 探讨贲门失弛缓症手术方法及效果。方法 回顾性分析36例贲门失弛缓症采用Heller＋Nissen手术治疗效果，男20例，女16例，平均年龄36岁，经胸手术32例，经腹手术4例，术中保护迷走神经，重建食管—胃His角和贲门功能，保护剥离食管黏膜创面。结果 36例无手术死亡，术后10天后均能进普食。随访5年，钡餐摄片，食管无狭窄，食管镜检查，2例食管下段轻度糜烂，余34例正常。结论 贲门失弛缓症行Heller＋Nissen手术效果好。     

贲门失弛缓症胸腔镜手术治疗

1995年 3月以来 ,我们对 31例病人行胸腔镜下贲门失弛缓症肌层切开术 ,取得较好治疗效果。现总结如下。临床资料　全组中男 13例 ,女 18例 ;年龄 10～ 6 9岁。病人有不同程度吞咽困难 6个月～ 30年。术前吞钡Ｘ线食管摄片显示 ,食管扩张直径 <4 0ｃｍ 1例 ,4 0～ 6 0ｃｍ 16例 ,>6 0ｃｍ 14例。 3例伴有不同程度胃下垂。术前曾口服药物治疗 2 8例 ,其中 10例曾施行贲门扩张术 ,1例扩张 3次。手术方法和结果　全组均经胸腔镜行食管贲门肌层切开术。病人右侧卧位 ,经左胸手术。腋中线第 4肋间切口为胸腔镜套管插入口 ,分别在腋前线第 6肋…     

胸腔镜手术治疗贲门失弛缓症

胸腔镜手术治疗贲门失弛缓症张晓林李含志刘永春谢周良程兆云钱如林１９９５年１０月至１９９６年６月，我们利用电视胸腔镜与气囊食管扩张器结合，为６例贲门失弛缓症病人进行了食管下段肌层和贲门括约肌切开术，效果满意，现报道如下：临床资料本组男女各３例，年龄２６...     

改良Heller手术治疗贲门失弛缓症64例

我科从1986年至2006年经腹行改良Heller手术及附加抗返流装置治疗贲门失弛缓症64例。现将治疗体会报告如下。临床资料1.一般资料:全组64例,男41例,女23例。年龄12~56岁,平均年龄34岁,病程0.5~20年。临床表现:全组均有不同程度的吞咽困难和体重下降。其中23例伴有进食后呕吐、溢     

48例贲门失弛缓症的外科治疗

目的 :为探讨贲门失弛缓症外科治疗理想术式。方法 :对贲门失弛缓症行Heller术 2 0例和改良Heller术加胃底覆盖 2 8例进行比较。结果 :行改良Heller术加胃底覆盖明显优于Heller术。结论 :改良Heller术加胃底覆盖值得推广。     

腹腔镜Heller手术治疗贲门失弛缓症的初步临床经验

目的总结腹腔镜Heller手术治疗贲门失弛缓症的初步临床经验。方法2005年2～8月，对肺功能较差、合并肾功能不全或怀疑存在胸膜腔粘连的8例贲门失弛缓症行腹腔镜下Heller联合Dor胃底折叠手术，并进行随访。结果手术时间70～184min，平均103．8min；1例术中食管穿孔改开腹手术修补成功；术后住院3～10d，平均5．1d。术后随访1～6个月，平均3．8月，7例症状缓解，1例轻度吞咽困难。全组无手术死亡。结论腹腔镜具有刨伤小、术中暴露较佳、术后恢复快、术后住院时间短等优点，腹腔镜下Heller术可作为贲门失弛缓症的首选治疗方法，但是否附加胃底折叠术仍需进一步探讨。     

腹腔镜改良Heller手术治疗贲门失弛缓症

目的:探讨腹腔镜改良Heller术治疗贲门失弛缓症的临床应用价值。方法:2004年2月至2008年4月我们为6例贲门失弛缓症患者行腹腔镜改良Heller术并随访。结果:手术时间45~122min,平均(74.0±29.0)min;术中出血5~65ml,平均(23.7±22.7)ml;无一例中转开腹及并发症发生;住院3~8d,平均(5.5±1.8)d。术后随访3~46个月,平均(26.8±16.2)月,5例症状缓解,1例轻度吞咽困难。结论:腹腔镜改良Heller手术具有术野清晰、并发症少、患者创伤小、康复快、住院时间短等优点,是治疗贲门失弛缓症首选方法之一。     

Results of laparoscopic Heller-Toupet operation for achalasia

Background Laparoscopic myotomy has become the preferred treatment for achalasia. Controversy persists on the need for fundoplication and/or its type; when used, most series have utilized the Dor fundoplication. We report a large series of laparoscopic Heller-Toupet procedures. Methods All patients operated for achalasia were entered into a prospective database. Pre and postoperative esophageal symptoms, satisfaction scores, and SF-36 variables were compared. Surgical failures were defined as recurrent or persistent dysphagia leading to secondary treatment. Data are expressed as mean ± S.D. Results One hundred consecutive cases were analyzed (61 men, 39 women, age 47 ± 17 yr). Heller-Toupet was performed in 94, whereas six patients had a Dor fundoplication because of mucosal perforation (three) or technical difficulties performing a posterior wrap (three). Operative time was 148 ± 21 min. There were 13 intraoperative adverse events managed laparoscopically, and no conversions. Minor postoperative complications were noted in two cases, whereas there were no major complications or deaths. Mean hospital stay was 1.2 ± 0.5 days, (range 1–4). Follow-up was complete in 92% at 26 ± 17 months. Failures leading to further treatment occurred in 4%. All symptom scores were significantly improved (p < 0.0001). Solid dysphagia score went from 6.4 to 1.0 postoperatively; regurgitation score went from 4.5 to 0.2 (combined frequency and severity, range 0–8). Postoperative global esophageal symptoms scale revealed improvement in 97%, and all domains of the SF-36 were improved. Conclusions Although the best surgical approach to achalasia is yet to be determined, laparoscopic Heller-Toupet operation in experienced hands is a safe and effective procedure with low rates of morbidity and failure and high patient satisfaction. Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) (oral presentation), Denver, CO, USA, April 2004     

腹腔镜Heller肌切开联合胃底折叠术在贲门失弛缓症治疗中的应用

目的:探讨腹腔镜Heller肌切开联合胃底折叠术(laparoscopic Heller myotomy with a Toupet fundoplication,LHT)治疗贲门失弛缓症的临床价值。方法:回顾分析2000年4月至2008年4月我院为48例贲门失弛缓症患者行LHT的临床资料。结果:手术均获成功,无中转开腹。手术时间65~150min,平均86min,术中出血5~50ml。术后平均住院5.2d。随访1~24个月,术前吞咽困难症状均缓解。结论:LHT具有定位准确、安全、可靠、创伤小、痛苦轻、疗效好等优点,同时可提高手术质量,减少并发症。LHT治疗贲门失弛缓症值得临床推广。     

两种手术方式治疗贲门失驰缓症探讨

目的探讨治疗贲门失驰缓症的理想术式。方法回顾性分析1998年3月至2007年3月手术治疗的贲门失驰缓症28例:经胸Heller术9例,经腹Heller术附加胃底折叠并幽门成形术19例。分析两种手术方式疗效间的差异。结果经胸Heller术9例中,治愈5例,好转1例,差3例。经腹Heller术附加胃底折叠并幽门成形术19例中,治愈18例,好转1例。两种手术方式疗效间的差异有统计学意义(P0.01)。结论经腹Heller术附加胃底折叠并幽门成形术是治疗贲门失驰缓症的较理想术式。     

外科和妇科腹腔镜联合手术160例报告

目的探讨腹腔镜技术在外科和妇科疾病治疗中联合应用的临床价值。方法2003年3月~2006年12月,因妇、外科疾病施行腹腔镜联合手术160例,分别为腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合输卵管造口术20例,LC联合卵巢囊肿剥除术24例,LC联合子宫肌瘤剔除术12例,LC联合双侧子宫动脉结扎加子宫肌瘤挖除术7例,LC联合子宫次全切除术19例,LC联合子宫全切除术11例,LC联合子宫内膜异位症手术6例;腹腔镜阑尾切除术(laparoscopic appendectomy,LA)联合输卵管手术16例,LA联合卵巢囊肿切除术22例,LA联合子宫全切除术或子宫次全切除术18例;腹腔镜肝囊肿开窗引流术联合卵巢囊肿切除术4例;腹腔镜肝段切除联合附件切除术1例。结果160例妇、外科联合腹腔镜手术均获成功,无中转开腹手术。手术时间40~220min,平均120min;术后住院1~6d,平均3.4d。无并发症。143例随访3~24个月,平均19.5月,1例术后10天阴道残端出血(保守治愈),1例术后2个月阴道残端息肉(手术切除)。结论严格掌握联合手术指征,充分术前准备,多科室良好配合...     

Laparoscopic esophagomyotomy for achalasia

Results of an ongoing clinical study treating achalasia patients with a transabdominal laparoscopic Heller myotomy and Toupet partial fundoplication are presented. Twelve patients underwent surgery between January 1992 and October 1993. All patients had barium esophagograms, preoperative endoscopy, esophageal manometry, 24-h pH studies, and extensive GI history preoperatively. Surgical complications included two perforations of the mucosa at the gastroesophageal junction repaired laparoscopically. There were no surgical mortalities and the average hospital stay was 39 h. Postoperatively all patients at follow-up had a repeat GI history, esophagogastroscopy, 24-h pH testing, and esophageal manometry. This follow-up showed good-to-excellent relief of dysphagia in all 12 patients with one patient complaining of heartburn documented to be from reflux postoperatively. Manometry showed a mean decrease in the lower esophageal sphincter pressure from 33.4 mmHg preoperatively to 19.3 mmHg postoperatively; 24-hour pH testing showed no significant reflux in the nine patients who had Heller myotomy plus a Toupet fundoplication. However, two of three patients who had Heller myotomy alone demonstrated abnormal 24-h pH testing. One of these patients was symptomatic and was found to have mild esophagitis by biopsy on postoperative endoscopy. These good results have persisted for mean follow-up of 16 months.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Nashville, TN, 18–19 April 1994     

Results of the laparoscopic Heller-Dor procedure for pediatric esophageal achalasia

Background: Esophageal achalasia is not a frequent disorder in children and different treatments have been proposed during past decades. This study reviews the results of the laparoscopic Heller-Dor procedure performed in pediatric patients in two different surgical units. Methods: We included the patients aged <14 years with a minimum follow-up of 6 months operated on in the period 1994–2001. A single longitudinal anterior esophageal myotomy (Heller) and a 180° anterior gastropexy (Dor) were laparoscopically performed. The patients were checked to detect intra- or postoperative complications and recurrence. Results: Twenty children were operated on. Mean follow-up was 45 months (range 6–102). Postoperative clinical score was Visick 1 in 15 cases and Visick 2 in five. Conclusions: As complication and recurrence rates are very low we consider modified Heller myotomy and Dor gastropexy through a laparoscopic approach our first choice to treat esophageal achalasia in the pediatric population.     

腹腔镜手术治疗胃食管反流病和贲门失弛缓症

目的:探索三种腹腔镜胃底折叠术治疗胃食管反流病及Heller肌切开术治疗贲门失弛缓症的安全性与可行性。方法:1995年12月至2004年9月,经腹腔镜手术治疗了胃食管反流病人45例和贲门失弛缓病人5例。术前常规行胃镜与上消化道钡餐检查者50例,加行食管测酸、测压检查者39例。腹腔镜单纯胃底折叠术10例(Nissen式1例,Toupet式9例);腹腔镜食管裂孔疝修补加胃底折叠术35例(Nissen式11例,Toupet式24例)。Heller肌切开术加Dor胃底折叠术5例。结果:全组病人的平均手术时间为120(60～360)min,术中平均出血量15(10～100)ml,术后日平均引流量20(10～100)ml,平均住院7(5～12)d。其中前10例使用电刀者平均用时210(180～360)min,中转开腹1例;后40例使用超声刀者平均用时100(60～180)min。术中脾被膜划破出血2例,12例Nissen式胃底折叠术后有1例出现吞咽困难,1月后缓解。42例获随访的病人中40例不再需要服药。其中5例Heller肌切开术Dor胃底折叠术病人术后第2天即可顺畅进食,且无反流。结论:与传统的经胸或经腹手术相比,腹腔镜抗反流手术治疗胃食管反流病和Heller肌切开贲门失弛缓症的病人具有心肺干扰小、麻醉难度低、创伤小、痛苦轻、并发症少、住院时间短、康复快、疗效好等突出优点。经过不断改进手术设计和加强训练可使?     

Long-term results of laparoscopic Heller myotomy with partial fundoplication for the treatment of achalasia

BACKGROUND: Treatment options for achalasia include medications, endoscopic balloon dilation, injection of botulinum toxin, or surgery. METHODS: The clinical course of 75 consecutive patients who underwent minimally invasive Heller myotomy and partial fundoplication for achalasia between 1991 and 2001 was reviewed by means of a questionnaire. RESULTS: Mean follow-up was 5.3 (range .8 to 10.9) years. Sixty-four percent of questionnaires were returned. Thirty-seven patients (84%) felt much better and 6 (14%) slightly better; 1 (2%) rated the result as unchanged. Twenty-six patients (59%) experienced weight gain. Seven patients (16%) had persistent swallowing problems and 5 (11%) reported frequent reflux. Twenty-five percent underwent additional therapy, including dilation (n = 8, 18%), repeat surgery (n = 2, 5%), and botulinum toxin injection (n = 2, 5%). Eighteen patients (41%) were using a proton pump inhibitor or H2 blocker, three were on a calcium channel blocker (7%), and 1 was using nitroglycerine (2%). CONCLUSION: Laparoscopic Heller myotomy can achieve short- and long-term results comparable to open surgery and should be considered the treatment of choice for patients suffering from achalasia. Despite the frequent need for further therapy, patient satisfaction is good.     

Heller myotomy for achalasia: quality of life comparison of laparoscopic and open approaches.

BACKGROUND: Achalasia is a relatively rare disorder with a variety of treatment options. Although laparoscopic Heller myotomy has become the surgical treatment of choice, little data exist on the overall quality of life of patients undergoing this technique versus standard open approaches. METHODS: We prospectively evaluated all patients surgically treated for achalasia by a single surgeon. Laparoscopic Heller myotomy consisted of a long (> or = 6 cm) esophageal cardiomyotomy extending at least 2 cm onto the gastric cardia, with a concomitant Dor fundoplication. Patients were evaluated preoperatively and postoperatively for symptoms and quality of life using the SF-36, a standardized, generic quality of life instrument. RESULTS: A total of 23 patients were surgically treated: 15 patients had a planned laparoscopic procedure, with 3 conversions; 8 had planned open procedures. Dysphagia resolved in 20 of 21 patients, with 1 patient in the laparoscopic group requiring reoperation due to an inadequate gastric myotomy. Compared with preoperative scores, a statistically significant improvement occurred in the general health domain of the SF-36 (70 to 82, P = 0.04). Compared with that in patients undergoing open surgery, the laparoscopic group had better scores in the domains of physical functioning and bodily pain. CONCLUSIONS: Laparoscopic Heller myotomy has comparable success to open Heller myotomy, and causes less early detriment to quality of life. This should be the primary treatment in all fit surgical patients with achalasia.