中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2013年
5期
533-535
,共3页
贲门%食管失弛缓症%Heller术%改良Dor术
賁門%食管失弛緩癥%Heller術%改良Dor術
분문%식관실이완증%Heller술%개량Dor술
Cardia%Esophageal achalasia%Heller%Improved Dor
目的 评价经腹行Heller术联合改良Dor术治疗贲门失弛缓症的临床疗效.方法 选择2006年1月至2011年12月贲门失弛缓症患者35例,均经腹行Heller术联合改良Dor术治疗,其中20例术前及术后均行食管测压检查及24h食管pH监测,对术前及术后食管下括约肌静息压(LESP)及24h内食管反流次数、最长反流时间、pH ＜4.0时间、pH ＜4.0时间百分比等指标进行统计学分析.结果 术后1例仍有吞咽困难,其余34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(10.22±8.91) mmHg较术前(30.81 ±6.63) mm Hg明显下降(t=20.185,P=0.008).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(t值分别为2.740、2.335、2.829、2.139,P值分别为0.022、0.019、0.036、0.040).随访32例(91.4％,32/35),其中症状消失24例(75.0％,24/32),改善8例(25.0％,8/32)；术前经24h食管下端pH监测证实其中4例(20.0％,4/20)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术联合改良Dor术除能明显改善贲门失弛缓症的症状外,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.
目的 評價經腹行Heller術聯閤改良Dor術治療賁門失弛緩癥的臨床療效.方法 選擇2006年1月至2011年12月賁門失弛緩癥患者35例,均經腹行Heller術聯閤改良Dor術治療,其中20例術前及術後均行食管測壓檢查及24h食管pH鑑測,對術前及術後食管下括約肌靜息壓(LESP)及24h內食管反流次數、最長反流時間、pH ＜4.0時間、pH ＜4.0時間百分比等指標進行統計學分析.結果 術後1例仍有吞嚥睏難,其餘34例癥狀明顯好轉.術後1箇月複查食管測壓檢查及24 h食管pH鑑測,LESP值(10.22±8.91) mmHg較術前(30.81 ±6.63) mm Hg明顯下降(t=20.185,P=0.008).24 h反流次數、最長反流時間、pH ＜4.0時間、pH ＜4.0時間百分比等指標較術前均有下降,差異均有統計學意義(t值分彆為2.740、2.335、2.829、2.139,P值分彆為0.022、0.019、0.036、0.040).隨訪32例(91.4％,32/35),其中癥狀消失24例(75.0％,24/32),改善8例(25.0％,8/32)；術前經24h食管下耑pH鑑測證實其中4例(20.0％,4/20)存在不同程度的胃食管反流,術後隨訪均無反流性食管炎髮生.結論 經腹行Heller術聯閤改良Dor術除能明顯改善賁門失弛緩癥的癥狀外,還能有效防止術後可能帶來的胃食管反流,且手術操作較簡單,創傷小,併髮癥少.
목적 평개경복행Heller술연합개량Dor술치료분문실이완증적림상료효.방법 선택2006년1월지2011년12월분문실이완증환자35례,균경복행Heller술연합개량Dor술치료,기중20례술전급술후균행식관측압검사급24h식관pH감측,대술전급술후식관하괄약기정식압(LESP)급24h내식관반류차수、최장반류시간、pH ＜4.0시간、pH ＜4.0시간백분비등지표진행통계학분석.결과 술후1례잉유탄인곤난,기여34례증상명현호전.술후1개월복사식관측압검사급24 h식관pH감측,LESP치(10.22±8.91) mmHg교술전(30.81 ±6.63) mm Hg명현하강(t=20.185,P=0.008).24 h반류차수、최장반류시간、pH ＜4.0시간、pH ＜4.0시간백분비등지표교술전균유하강,차이균유통계학의의(t치분별위2.740、2.335、2.829、2.139,P치분별위0.022、0.019、0.036、0.040).수방32례(91.4％,32/35),기중증상소실24례(75.0％,24/32),개선8례(25.0％,8/32)；술전경24h식관하단pH감측증실기중4례(20.0％,4/20)존재불동정도적위식관반류,술후수방균무반류성식관염발생.결론 경복행Heller술연합개량Dor술제능명현개선분문실이완증적증상외,환능유효방지술후가능대래적위식관반류,차수술조작교간단,창상소,병발증소.
Objective To evaluate the effect of treating achalasia of cardia by transabdominally HellerDor operation.Methods Thirty-five cases with achalasia of cardia who were treated by transabdominally Heller-Dor procedure were recruited in this study from January 2006 to December 2011.Twenty patients received preand post-operative manometry and 24-hour-pH monitoring.Recorded parameters included pre-and post-operative lower esophageal sphincter pressure (LESP),reflux frequency in 24 hours,the longest duration of reflux,the total time (min) of pH ＜ 4.0 and the percentage (％) of time of pH ＜ 4.0.Statistical analyses were conducted.Results Symptom was significantly improved in 34 patients after surgery,while 1 patient remained dysphasia.Recheck the manometry and 24-hour-pH post-operation at 1 month,the LESP was significantly lower than pre-operation ((10.22 ±8.91)mm Hg vs.(30.81 ±6.63) mm Hg,and the reflux frequency,the longest duration of reflux,the total time (min) of pH ＜ 4.0 and the percentage (％) of time of pH ＜ 4.0 significantly declined at one month after operations (t =2.740,2.335,2.829 and 2.139;P =0.022,0.019,0.036 and 0.040 respectively).Thirty-two patients (91.4％,32/35) were followed up,among whom 24 patients (75.0％,24/32) were cured and 8 patients(25.0％,8/32) improved.Reflux did not detected after surgery in the 4 cases (20.0％,4/20) with preoperative reflux.Conclusion Transabdomianlly Heller-Dor operation could dramatically alleviate the symptoms of patients with achalasia of cardia.Moreover,it could especially prevent pestoperative-reflux,with the advantages of simple operations,little traumas and few complications.
