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目的通过对胸腔镜手术治疗贲门失弛缓症(AC)对食管功能改变、症状改善等方面的回顾性临床研究,评价胸腔镜手术治疗在临床中的应用价值。方法回顾性分析贵州医科大学附属医院胸外科2012年3月至2014年9月行胸腔镜下改良Heller手术34例AC患者的临床资料,其中男11例、女23例,中位年龄35(11~67)岁。根据患者治疗和随访时间分为术前组、术后1个月组、术后3个月组和术后6个月组。对患者治疗前后的临床症状变化、影像学改变、食管动力学改变等进行客观数据统计,应用统计学方法分别对不同分组的情况进行分析。结果各组患者年龄、性别差异无统计学意义(P>0.05)。全组病例术中操作顺利,术中未出现相应并发症、死亡。经外科手术治疗后患者相应症状不同程度上得到改善,且术前、术后临床症状评分有明显下降趋势(P<0.05)。除食管下括约肌长度(LESL)较术前变化程度较小(P>0.05)外,食管下括约肌静息压(LESP)、食管下括约肌松弛压(LESRP)、食管体部静息压(EBP)均较术前明显降低,食管下括约肌松弛率(LESRR)较术前提高,差异均有统计学意义(P<0.05)。术前组与术后3个月组对比食管钡餐造影食管最大宽度明显缩小(P<0.05)。随访中3例患者出现胃食管反流,2例术后发生食管穿孔,1例术后因食管胸膜瘘导致脓胸。无上消化道大出血、食道裂孔疝等并发症发生。结论外科手术治疗可明显缓解患者的临床症状,改善食管动力,且具有简单易行、术后并发症少、远期疗效显著等优点。胸腔镜下改良Heller手术极大地减少了传统开胸手术的创伤,由于其微创的特点,已被广泛认可。食管测压可对该病的诊断、患病程度及疗效起到客观指导作用。
Objective To evaluate the value of thoracoscopic surgery in the treatment of thoracoscopic surgery for the treatment of achalasia (esophageal achalasia) on esophageal function and improvement of symptoms. Methods The clinical data of 34 AC patients undergoing thoracoscopic modified Heller operation from March 2012 to September 2014 were retrospectively analyzed. Thirty-seven males and 23 females with a median age of 35 (11 ~ 67) years old. According to the patients’ treatment and follow-up time, they were divided into preoperative group, postoperative 1 month group, postoperative 3 month group and postoperative 6 month group. Before and after treatment of patients with clinical symptoms, imaging changes, changes in esophageal motility and other objective data statistics, statistical methods were used to analyze the different groups. Results There was no significant difference in age and gender between the two groups (P> 0.05). All patients in the operation was successful, no complications during operation, and died. The corresponding symptoms of patients after surgical treatment improved to varying degrees, and preoperative and postoperative clinical symptom scores decreased significantly (P <0.05). In addition to the lower esophageal sphincter length (LESL), the lower esophageal sphincter resting pressure (LESP), the lower esophageal sphincter relaxation pressure (LESRP), the esophageal resting pressure (EBP) Compared with the preoperative, the esophageal sphincter relaxation rate (LESRR) was significantly lower than that before operation, the difference was statistically significant (P <0.05). The maximum width of esophageal barium meal esophageal contrast in preoperative group and postoperative 3 month group was significantly reduced (P <0.05). Gastroduodenal reflux occurred in 3 patients, esophageal perforation in 2 patients and empyema in 1 patient due to esophageal pleural fistula. No upper gastrointestinal bleeding, esophageal hiatal hernia and other complications. Conclusion Surgical treatment can significantly relieve the clinical symptoms of patients, improve esophageal motility, and has the advantages of simple and easy, less postoperative complications, long-term curative effect. Thoracoscopic modified Heller surgery has greatly reduced the trauma of traditional thoracic surgery, which has been widely recognized due to its minimally invasive features. Esophageal manometry can play an objective guiding role in the diagnosis, prevalence and efficacy of the disease.