改良三孔法腹腔镜下Heller肌切开联合胃底折叠治疗贲门失弛缓症

目的探讨三孔法腹腔镜下Heller肌切开联合胃底折叠治疗贲门失迟缓症的效果及优势。方法回顾性分析我院2006年7月～2011年10月完成的26例腹腔镜下Heller肌切开联合胃底折叠术的临床资料。手术采用三孔法，术中使用自制简易拉钩，行Heller肌切开联合Dor胃底折叠，观察术中及术后相关指标并随访。结果所有手术均获得成功，无中转开腹，手术时间65—260min，平均110．6rain。出血量25～100ml，平均53．2ml。术后住院时间3～7d，平均5．8d。1例术中食管黏膜破裂，修补后无食管漏。术后随访18～72个月，平均34．7月，无复发，饮食无明显不适。结论三孑L法腹腔镜下Heller肌切开联合胃底折叠治疗贲门失弛缓症具有手术部位显露效果好，创伤小，恢复快，治疗效果确切，安全，并发症少等优点，术后病人腹部美观，是治疗贲门失弛缓症的良好微创途径。

Modified Three-port Laparoscopic Heller Myotomy and Fundoplication for the Treatment of Achalasia of Cardia

Objective To explore the effects and benefits of three-port laparoscopic Heller myotomy and fundoplication for the treatment of achalasia of cardia. Methods Retrospective analysis was conducted on the clinical data of 26 cases in our hospital from July 2006 to October 2011. The operation of laparoscopic Heller myotomy and fundoplication was accomplished with three-port procedure. Homemade liver retractor was used in the surgery. The intraoperative and postoperative related indicators were observed and followed up. Results All operations were successful and none of them was converted to open surgery. The operation time was 65 rain to 260 min （ average, 110.6 rain） ; blood loss was 25 ml to 100 ml （ average, 53.2 ml） ; postoperative hospital stay was 3 d to 7 d （average, 5.8 d）. Mucous membrane rupture occurred in one case and no esophageal leakage occurred. The patients were followed up for 18 to 72 months （ average, 34. 7 months）. No recurrence or obvious discomfort occurred. Conclusions Three-port laparoscopic Heller myotomy and fundoplication for the treatment of achalasia of cardia has the advantage of causing less trauma, quick recovery, being safe and having fewer complications. Postoperative abdominal appearance was pleasant. It is one of the best minimally invasive approaches for the treatment of achalasia of eardia.