术中食管测压对改良Heller手术的指导价值

目的 探讨改良Heller手术中食管下括约肌的压力变化,确定食管、贲门肌层切开的长度和比例.方法 2006年5月至2007年12月采用改良Heller加Toupet抗反流手术治疗贲门失弛缓症患者15例,其中男性6例,女性9例;年龄28～61岁,术前病程6个月～9年.利用台式高分辨八通道胃肠动力监测系统,术中采用定点牵拉法监测食管下段四个方向食管下括约肌压力变化,并测量食管、贲门肌层切开的适宜长度.结果 全组无手术夕匕亡病例.食管贲门肌层切开的长度为5～8 cm.当食管侧切开长度为(5.3±1.5)am时,胃-食管连接处括约肌压力切开侧由(33.6±13.3)mm Hg(1 mm Hg=0.133 kPa)降至(9.7±4.6)mm Hg.胃侧切开长度(0.8±0.4)cm后,压力降至(4.8±3.1)null Hg.食管、贲门肌层切开前后,食管下括约肌压力明显降低(P<0.05).结论 术中食管测压可指导改良Heller于术中食管、贲门肌层切开的长度,为提高改良HeUer手术技术提供有用的信息.

Intraoperative esophageal manometry employed in the course of Heller's cardiamyotomies

Objective To study the changes of lower esophageal sphincter (LES) high-pressure zone, and to determine the accurate length of myotomy on the esophageal and gastric sides.Methods There were 15 patients undergoing the Heller's eardiamyotomies and Toupet fundoplications from May 2006 to December 2007.Among them, 9 patients were female and 6 was male.The age ranged from 28 to 61 years old, and the disease duration ranged from 6 months to 9 years. The intraoperative oesophageal manometry underwent in the surgical procedures to investigate the changes of the lower esophageal sphincter pressure and the length of myotomy.Results There was no postoperative death.After ( 5.3±1.5 ) cm of esophageal side myotomy and ( 0.8±0.4 ) cm of gastric side myotomy, the mean LES pressure decreased from (33.6±13.3) mm Hg (1 mm Hg=0.133 kPa) to (9.7±4.6) mm Hgand (4.8±3.1) mm Hg respectively ( P <0.05 ). The lower esophageal sphincter length ranged from 5 to 8 era. Conclusion Intraoperative esophageal manometry helps determine the accuratemyotomy length of myotomy on the esophageal and gastric sides of the gastroesophageal junction and provides valuable information for the Heller's myotomy.