膈肌脚在贲门食管区疾病手术治疗中作用

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1、膈肌脚在贲门食管区疾病手术治疗中作用［摘要］目的：研究和总结膈肌脚在贲门食管区疾病手术中的作用。方法：回顾性分析研究1998年1月〜2009年12月我院腹腔镜和开腹手术治疗贲门食管区疾病的临床资料，选取符合入组条件的住院贲门食管区疾病手术患者140例，将所有患者按手术路径分为两组，对照组40例(经胸组31例，经胸腹组9例)，治疗组经腹100例。通过切开膈肌脚、扩大食管裂孔、膈肌成形重建食管裂孔，手术治疗贲门失弛缓症、贲门癌、胃上部癌112例；缝合、收紧、修补膈肌脚治疗反流性食管炎、胃食管反流病、食管裂孔疝28例；分析

2、膈肌脚、迷走神经等解剖标志的识别方法。结果：本组贲门食管区疾病手术，手术时间明显缩短，术中出血少，部分患者避免了经胸手术，无严重手术并发症，术后长期疗效确切。结论：膈肌脚是贲门食管区的重要的解剖结构，通过切开膈肌脚，扩大食管裂孔，缝合、收紧膈肌脚，腔镜手术，解剖标志膈肌脚的正确识别，比较合理、准确、有效的手术治疗贲门食管区疾病。［关键词］膈肌脚；食管；贲门；胃；手术［中图分类号］R573.7［文献标识码］B［文章编号］1673-7210(2011)11(a)-190-03Functionondiaphragmatic

3、footinthesurgicaltreatmentofcardiaesophagealregionSHEDeguoYangtzeRiverHospitalofRugaoCity,JiangsuProvince,Rugao226532,China[Abstract]Objective：Tostudyandsummarizethefunctionondiaphragmaticfootinthesurgicaltreatmentofcardiaesophagealregion.Methods：Aretrospective

4、analysisoftheclinicaldataofcardiacesophagealregiontreatedwithlaparoscopyandlaparotomysurgeriesfromJanuary1998toDecember2009wascarriedout・140patientswithcardiaesophagealregiontreatedwithsurgerywereeligibleforinclusion.Allpatientsweredividedintotwogroupsaccording

5、tothesurgicalapproach,with40patients(31patientsforthetransthoracicgroupand9patientsforthetransabdominalgroup)forthecontrolgroupand100transabdominalpatientsforthetreatmentgroup.112patientswithcardiaachalasia,cardiacanceranduppergastriccancerreceivedsurgicaltreat

6、mentbycuttingopenthediaphragmfoot,expandingesophagealhiatusandreconstructingesophagealhiatuswithdiaphragmshaping・28patientswithrefluxesophagitis,gastroesophagealrefluxdiseaseandhiatalherniareceivedsurgicaltreatmentbysuturing,tighteningandrepairingdiaphragmaticf

7、oot・Identificationmethodsofanatomiclandmarkssuchasthevagusnervewereanalyzed.Results：Thisgroupofsurgeriesfordiseasesincardiacesophagealregionhadshortersurgicaltime,lessbloodloss,fewertransthoracicoperations,noseriouscomplicationsandgoodpostoperativelong-termcura

8、tiveeffects・Conclusion：Diaphragmaticfootisanimportantanatomicalstructureinthecardiaesophagealregion.Bycuttingopenthediaphragmfootandexpandingesophagealhiatus,suturingandtigh