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。

Laparoscopic Heller Myotomy with Gastroscopy for Treatment of Esophageal Achalasia

Objective To investigate the feasibility and clinical effectof laparoscopic mini - invasive surgery to treat achalasia of the cardia. Methods Five patients with esophageal achalasia underwent Gastroscopy and received laparo- scopic Heller＇ s myotomy. Results Four patients got excellent operative effects after surgery . However , the other one pa- tient had severe adhesions resulting in rupture of the distalesophagus during dissection that was discovered by gastroscopy, so the rupture was immediately repaired by closure. Many symptoms obviously released shortly after operation. In two pa- tients dysphagia disappeared one week after operation through changing diet. Follow - up for 5 to 17 months showed none of the five patients had any dysphagia, vomiting, reflux, and chest pain again. Conclusion Laparoscopic Heller my- otomy combined with gastroscopy during operation in the treatment of esophageal achalasia is advantageous in minimal in- vasion, fast recovery and less pain , hence a remedic therapy when the medical treatments have failed.