中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2010年
12期
888-892
,共5页
周峻%李龙%李索林%黄柳明%张晓伦%孔赤寰%张军%刘树立%吴涛%李颀%董宁
週峻%李龍%李索林%黃柳明%張曉倫%孔赤寰%張軍%劉樹立%吳濤%李頎%董寧
주준%리룡%리색림%황류명%장효륜%공적환%장군%류수립%오도%리기%동저
食管失弛症%腹腔镜外科手术
食管失弛癥%腹腔鏡外科手術
식관실이증%복강경외과수술
Esophageal achalasia%Laparoscopic surgical procedures
目的 通过回顾经治的贲门失弛缓症手术病例,比较传统的开放Heller手术和腹腔镜手术疗效的差异.方法 2002年10月至2009年10月间共有22例贲门失弛缓症儿童接受手术治疗,按不同的手术方式分为开放手术组(n=12)和腹腔镜手术组(n=10).2组病例均采用改良的Heller肌层纵行切开术,且全部附加部分胃底折叠术.通过2组术后住院时间、术后进固体食物时间比较2种手术的短期疗效.通过术后随访的症状评分、造影食管上段最大横径差和食管下段最窄横径差等指标,比较2组患儿手术的长期疗效.结果 比较开放手术组和腹腔镜组患儿病程(27.3±23.7和30.7±36.3)、术前症状评分(5.7±2.4和6.1±1.9),差异均无统计学意义(P=0.796,P=0.652).二组手术均顺利完成,无术中输血者及严重术中并发症者,腹腔镜手术无中转,腹腔镜组失血量(5.9±5.0)ml明显少于开放于术组(26.7±13.2)ml(P＜0.01),手术时间(98.5 min±23.2 min和118.8min±22.8min)的差异无统计学意义(P=0.053).二组患儿术后平均症状评分均接近0分(P=0.899),但腹腔镜组术后住院时间(4.3±1.3)d和术后进食固体食物时间(7.7±4.1)d显著短于开放手术组(7.8±1.3)d和(17.4±11.1)d,(P＜0.01和P=0.014).经过(45.1±26.6)个月的随访,食管最大横径差(9.9mm±7.9mm和6.6 mm±5.6mm)和食管下端最窄横径差(5.5 mm±4.8mm和5.2 mm±2.3 mm)两项指标在2组间比较的差异无统计学意义(P=0.275,P=0.830),2组中所有病例均无吞咽困难复发、无胃食管反流等并发症者.结论 对儿童贲门失弛缓症,腹腔镜Heller手术能达到与传统开放经腹Heller手术相同的长期疗效,且术后近期疗效明显优于开放手术.
目的 通過迴顧經治的賁門失弛緩癥手術病例,比較傳統的開放Heller手術和腹腔鏡手術療效的差異.方法 2002年10月至2009年10月間共有22例賁門失弛緩癥兒童接受手術治療,按不同的手術方式分為開放手術組(n=12)和腹腔鏡手術組(n=10).2組病例均採用改良的Heller肌層縱行切開術,且全部附加部分胃底摺疊術.通過2組術後住院時間、術後進固體食物時間比較2種手術的短期療效.通過術後隨訪的癥狀評分、造影食管上段最大橫徑差和食管下段最窄橫徑差等指標,比較2組患兒手術的長期療效.結果 比較開放手術組和腹腔鏡組患兒病程(27.3±23.7和30.7±36.3)、術前癥狀評分(5.7±2.4和6.1±1.9),差異均無統計學意義(P=0.796,P=0.652).二組手術均順利完成,無術中輸血者及嚴重術中併髮癥者,腹腔鏡手術無中轉,腹腔鏡組失血量(5.9±5.0)ml明顯少于開放于術組(26.7±13.2)ml(P＜0.01),手術時間(98.5 min±23.2 min和118.8min±22.8min)的差異無統計學意義(P=0.053).二組患兒術後平均癥狀評分均接近0分(P=0.899),但腹腔鏡組術後住院時間(4.3±1.3)d和術後進食固體食物時間(7.7±4.1)d顯著短于開放手術組(7.8±1.3)d和(17.4±11.1)d,(P＜0.01和P=0.014).經過(45.1±26.6)箇月的隨訪,食管最大橫徑差(9.9mm±7.9mm和6.6 mm±5.6mm)和食管下耑最窄橫徑差(5.5 mm±4.8mm和5.2 mm±2.3 mm)兩項指標在2組間比較的差異無統計學意義(P=0.275,P=0.830),2組中所有病例均無吞嚥睏難複髮、無胃食管反流等併髮癥者.結論 對兒童賁門失弛緩癥,腹腔鏡Heller手術能達到與傳統開放經腹Heller手術相同的長期療效,且術後近期療效明顯優于開放手術.
목적 통과회고경치적분문실이완증수술병례,비교전통적개방Heller수술화복강경수술료효적차이.방법 2002년10월지2009년10월간공유22례분문실이완증인동접수수술치료,안불동적수술방식분위개방수술조(n=12)화복강경수술조(n=10).2조병례균채용개량적Heller기층종행절개술,차전부부가부분위저절첩술.통과2조술후주원시간、술후진고체식물시간비교2충수술적단기료효.통과술후수방적증상평분、조영식관상단최대횡경차화식관하단최착횡경차등지표,비교2조환인수술적장기료효.결과 비교개방수술조화복강경조환인병정(27.3±23.7화30.7±36.3)、술전증상평분(5.7±2.4화6.1±1.9),차이균무통계학의의(P=0.796,P=0.652).이조수술균순리완성,무술중수혈자급엄중술중병발증자,복강경수술무중전,복강경조실혈량(5.9±5.0)ml명현소우개방우술조(26.7±13.2)ml(P＜0.01),수술시간(98.5 min±23.2 min화118.8min±22.8min)적차이무통계학의의(P=0.053).이조환인술후평균증상평분균접근0분(P=0.899),단복강경조술후주원시간(4.3±1.3)d화술후진식고체식물시간(7.7±4.1)d현저단우개방수술조(7.8±1.3)d화(17.4±11.1)d,(P＜0.01화P=0.014).경과(45.1±26.6)개월적수방,식관최대횡경차(9.9mm±7.9mm화6.6 mm±5.6mm)화식관하단최착횡경차(5.5 mm±4.8mm화5.2 mm±2.3 mm)량항지표재2조간비교적차이무통계학의의(P=0.275,P=0.830),2조중소유병례균무탄인곤난복발、무위식관반류등병발증자.결론 대인동분문실이완증,복강경Heller수술능체도여전통개방경복Heller수술상동적장기료효,차술후근기료효명현우우개방수술.
Objective To compare the efficacy between laparoscopic and open Heller's operation for pediatric esophageal achalasia. Methods A total of 22 children with esophageal achalasia underwent transabdominal surgical treatment in the authors' institutions from October 2002 to October 2009. According to operative approach, all cases were divided into two groups, open surgery group (n= 12) and laparoscopic group (n = 10). Modified Heller esophagomyotomy associated with a partial fundoplication was performed for each patient. Perioperative data including symptom scoring, duration of surgery, blood loss, conversion to open surgery, intraoperative mucosal tear, morbidity, length of hospital stay and solid feeding resumption time were analyzed. Based on postoperative symptom scoring and radiologic diameter of the esophagus, long term outcomes were evaluated between these 2 groups. Results No significant difference was noted in illness course (27. 3 ± 23. 7 vs. 30. 7 ± 36. 3,P = 0. 796) or preoperative symptom scoring (5. 7 ± 2. 4 vs. 6. 1 ± 1. 9, P = 0. 652) between 2 groups.Both procedures were performed without severe intraoperative complications or blood transfusion. No conversion to open surgery was applied in the laparoscopic group. Both group had similar operative time [(118. 8 ± 22. 8)min vs. (98. 5 ± 23. 2)min, P = 0. 053], while less blood loss was noted in the laparoscopic group than that in the open surgery group [5.9 ± 5. 0) ml vs. (26. 7 ± 13. 2) ml, P＜0. 01]. The postoperative symptom scoring of both groups were close to 0 (P = 0. 899), but mean postoperative length of hospital stay and resumption of solid feedings in the laparoscopic group (4. 3 d ± 1.3 d and 7. 7 d ± 4. 1 d) were significantly less than those in the open group (7. 8 d ± 1.3 d and 17. 1 d ± 11. 1 d,P＜00. 01 and P = 0. 014, respectively). There was no recurrent dysphasia or postoperative gastroesophageal reflux in any patient during follow-up period [(45. 1 ± 26. 6) months]. No significance of the mean differences of maximal esophageal diameter (9. 9 mm ± 7. 9 mm vs. 6. 6 mm ± 5. 6 mm) or minimal lower esophageal diameter (5. 5 mm ± 4. 8 mm vs. 5. 2 mm ± 2. 3 mm) was noted between 2 groups (P = 0. 275 and P = 0. 830). Conclusions The short term outcomes of laparoscopic Heller's procedure for patients with esophageal achalasia are obviously superior to open procedure,while the long-term efficacy for both procedures is equal.
