食道アカラシアに対する腹腔鏡下Heller-Dor法21例の検討

Results of 21 cases of laparoscopic Heller myotomy with Dor fundoplication for achalasia

◆要旨：1995～2006年までに食道アカラシアに対して施行した腹腔鏡下Heller-Dor法21例を検討した．平均手術時間は182分（130～253分），平均出血量は51ml（少量～160ml）であった．粘膜穿孔を2例に認めたが腹腔鏡下に縫合閉鎖し，術後に合併症を認めなかった．経口摂取までの期間は平均1.4日（1～4日），術後平均入院期間は7日（4～12日）であった．全例で症状の改善を認め，術前と術後1年の体重では有意差をもって体重の増加を認めた．平均観察期間は49.3か月（1～112か月）で，症状の再燃は認めていない．腹腔鏡下Heller-Dor法は低侵襲性かつ効果的な治療法であり，治療の第一選択になりえると考えられる．

　We reviewed and discussed 21 cases which underwent laparoscopic Heller myotomy with Dor fundoplication for achalasia at our hospital. The mean operative time was 182 min（range : 130～253 min）and estimated blood loss was 51 ml（range, minimal～160 ml）. Mucosal perforation occurred in 2 cases, but they were repaired at the time of the laparoscopic surgery and the patients had no sequelae. Diet was started on 1.4 POD（range, 1-4）and the mean postoperative hospital stay was 7 days（range, 4-12）. The rate of symptomatic relief was 100%and there was significant body weight gain between preoperative time and one year after the operation. There is no recurrence of symptoms and severe postoperative complications during mean 49.3 months follow-up（range, 1-112 months）. Laparoscopic Heller myotomy with Dor fundoplicaion for Achalasia is less invasive and effective treatment and seems to be the first-line therapeutic approach.