膈肌脚在贲门食管区疾病手术治疗中的作用(1)
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[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)-190-03
Function on diaphragmatic foot in the surgical treatment of cardia esophageal region
SHE Deguo
Yangtze River Hospital of Rugao City, Jiangsu Province, Rugao 226532, China
[Abstract] Objective: To study and summarize the function on diaphragmatic foot in the surgical treatment of cardia esophageal region. Methods: A retrospective analysis of the clinical data of cardiac esophageal region treated with laparoscopy and laparotomy surgeries from January 1998 to December 2009 was carried out. 140 patients with cardia esophageal region treated with surgery were eligible for inclusion. All patients were divided into two groups according to the surgical approach, with 40 patients (31 patients for the transthoracic group and 9 patients for the transabdominal group) for the control group and 100 transabdominal patients for the treatment group. 112 patients with cardia achalasia, cardia cancer and upper gastric cancer received surgical treatment by cutting open the diaphragm foot, expanding esophageal hiatus and reconstructing esophageal hiatus with diaphragm shaping. 28 patients with reflux esophagitis, gastroesophageal reflux disease and hiatal hernia received surgical treatment by suturing, tightening and repairing diaphragmatic foot. Identification methods of anatomic landmarks such as the vagus nerve were analyzed. Results: This group of surgeries for diseases in cardiac esophageal region had shorter surgical time, less blood loss, fewer transthoracic operations, no serious complications and good postoperative long-term curative effects ......
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