目的

探讨腹腔镜联合胃镜行Heller肌切开术、食管裂孔疝修补及Dor胃底折叠术的可行性，明确该联合术式的手术技巧及临床疗效，为临床提供兼顾功能修复与解剖重建的规范化方案。

方法

回顾性分析2014年6月至2024年10月在新疆维吾尔自治区人民医院微创外科、疝和腹壁疝外科收治的19例贲门失弛缓症合并食管裂孔疝患者的临床资料，均采用腹腔镜联合胃镜行Heller肌切开食管裂孔疝修补术联合Dor胃底折叠术治疗，分析手术时间、术中出血量、并发症及术后复发情况，并进行随访观察。

结果

19例患者均通过胃镜、上消化道造影及高分辨率食管测压明确诊断为贲门失弛缓症，其中芝加哥分型Ⅰ型2例、Ⅱ型15例、Ⅲ型2例，均手术顺利，1例患者中转开胸，手术时间为82（57～185）min，术中出血20（10～50）ml，未发生胃食管瘘，术后住院时间为3.0（2～6）d。术后随访时间为37（5～122）个月，术后短期吞咽困难2例，无复发病例，无术后严重胃食管反流病例。

结论

腹腔镜Heller肌切开联合食管裂孔疝修补及Dor胃底折叠术安全有效，但需扩大样本量验证远期疗效。

Objective

The feasibility of laparoscopic combined gastroscopy for Heller muscle incision， hiatal hernia repair and Dor fundoplication was discussed， and the surgical techniques and clinical efficacy of this combined operation were defined， so as to provide a standardized scheme for clinical functional repair and anatomical reconstruction.

Methods

A retrospective analysis was conducted on clinical data from 19 patients with achalasia and hiatal hernia treated in the Department of Minimally Invasive， Hernia and Abdominal Wall Surgery at Xinjiang Uygur Autonomous Region People's Hospital between June 2014 and October 2024. All patients underwent laparoscopic Heller myotomy combined with hiatal hernia repair and Dor fundoplication assisted by endoscopy. Operative time， intraoperative blood loss， complications， and recurrence were analyzed， with follow-up observations.

Results

All 19 patients were definitively diagnosed with achalasia via gastroscopy， upper gastrointestinal contrast， and high-resolution manometry. According to the Chicago Classification， 2 cases were typeI， 15 cases were type Ⅱ， and 2 cases were type Ⅲ. The surgeries were successful， with 1 case converted to thoracotomy. The median operative time was 82 （57-185） minutes， intraoperative blood loss was 20 （10-50） ml， and no gastroesophageal fistula occurred.The median postoperative hospital stay was 3.0 （2-6） days. During a median follow-up of 37 months （5-122 months）， 2 cases experienced transient dysphagia， but no recurrence or severe gastroesophageal reflux was observed.

Conclusion

Laparoscopic Heller myotomy combined with hiatal hernia repair and Dor fundoplication is safe and effective. However， larger sample sizes are required to validate long-term efficacy.