CAJ | 학술논문

目的评价经腹行Heller术加改良Dor术治疗贲门失弛症的疗效.方法经腹行Heller加改良Dor手术治疗贲门失弛症病人33例,其中18例术前及术后均行食管测压检查及24 h食管pH监测,对术前及术后食管下括约肌静息压(LESP)及24 h内食管反流次数、最长反流时间(min)、pH＜4.0时间(min)、pH＜4.0时间百分比(%)等指标进行统计学分析.结果术后1例仍有吞咽困难,其余32 例症状明显好转.术后1个月复查食管测压检查及24 h食管pH监测,LESP值较术前明显下降(P＜0.001).24 h反流次数、最长反流时间、pH＜4.0时间、pH＜4.0时间百分比等指标较术前均有下降,差异均有统计学意义(P＜0.05).随访30例(90.9%,30/33例),其中症状消失22例(73.3%,22/30例),改善8例(26.7%,8/30例);术前经24 h食管下端pH监测证实其中3例(16.7%,3/18例)存在不同程度的胃食管反流,术后随访均无反流性食管炎发生.结论经腹行Heller加改良Dor手术除能明显改善贲门失弛症的症状外,还能有效防止术后可能带来的胃食管反流,且手术操作较简单,创伤小,并发症少.
목적 평개경복행Heller술가개량Dor술치료분문실이증적료효.방법 경복행Heller가개량Dor수술치료분문실이증병인33례,기중18례술전급술후균행식관측압검사급24 h식관pH감측,대술전급술후식관하괄약기정식압(LESP)급24 h내식관반류차수、최장반류시간(min)、pH＜4.0시간(min)、pH＜4.0시간백분비(%)등지표진행통계학분석.결과 술후1례잉유탄인곤난,기여32 례증상명현호전.술후1개월복사식관측압검사급24 h식관pH감측,LESP치교술전명현하강(P＜0.001).24 h반류차수、최장반류시간、pH＜4.0시간、pH＜4.0시간백분비등지표교술전균유하강,차이균유통계학의의(P＜0.05).수방30례(90.9%,30/33례),기중증상소실22례(73.3%,22/30례),개선8례(26.7%,8/30례);술전경24 h식관하단pH감측증실기중3례(16.7%,3/18례)존재불동정도적위식관반류,술후수방균무반류성식관염발생.결론 경복행Heller가개량Dor수술제능명현개선분문실이증적증상외,환능유효방지술후가능대래적위식관반류,차수술조작교간단,창상소,병발증소.
Objective To evaluate the effect of curing achalasia by transabdominally Heller-Dor operation. Methods To summarize 33 cases of achalasia treated by transabdominally Heller-Dor procedure and visit them postoperatvely. 18 patients receive pre- and post-operativemanometry and 24-hour-pH monitoring. The parameters including reflux frequency 、the longest lasting-time of reflux 、the total time(min) of pH ＜4.0 and the percentage( % ) of time of pH ＜4.0 were recorded and compared using statistical mothods. Results Symptom was significantly improved in 32 patients after surgery, while 1 patient remained dysphasia as pre-operative. The LESP, the reflux frequency、the longest lasting-time of reflux 、the total time(min) of pH ＜ 4.0 and the percentage ( % ) of time of pH ＜ 4.0 also declined after operations ( P ＜ 0. 05 ). 30 patients were followed up,22 (73.3% ,22/30) were cured and 8 had mild sypmtom. Reflux did not detected in 3 cases( 16.7% ,3/18 ) with preoperative reflux. Conclusion Transabdominally Heller-Dor operation could dramadically alleviate the symptoms of patients with achalasia, moreover, it could especially prevent the postoperative-reflux, and with the advantages of simple operations, little traumas.