腹腔镜下Heller肌切开术的早期结果不一定能预测长期疗效。

Early results of laparoscopic Heller myotomy do not necessarily predict long-term outcome.

作者信息

Bloomston Mark, Durkin Alan, Boyce H Worth, Johnson Milton, Rosemurgy Alexander S

机构信息

Department of Surgery, University of South Florida, P.O. Box 1289, Room F-145, Tampa, FL 33601, USA.

出版信息

Am J Surg. 2004 Mar;187(3):403-7. doi: 10.1016/j.amjsurg.2003.12.003.

DOI:10.1016/j.amjsurg.2003.12.003

PMID:15006571

Abstract

BACKGROUND

We sought to evaluate how patients' symptoms evolve after laparoscopic Heller myotomy.

METHODS

Before and after laparoscopic Heller myotomy, 88 patients graded dysphagia and heartburn on a Likert scale (0 = none; 5 = severe). Patients graded outcomes as excellent, good, fair, or poor. Outcomes were compared in the same patients at 1 and 3 years of follow-up.

RESULTS

At early follow-up (10.6 +/- 7.8 months) significant reductions were noted in dysphagia (11% versus 100%), dysphagia scores (0.6 +/- 1.1 versus 4.7 +/- 0.7), heartburn (31% versus 72%), and heartburn scores (1.2 +/- 1.6 versus 2.7 +/- 1.9). By late follow-up (37.6 months +/- 18.0) these values increased (47%, 1.9 +/- 1.7, 48%, 1.8 +/- 1.5, respectively) but remained significantly reduced compared with before operation. Excellent/good outcomes at early and late follow-up were 89% and 85%, respectively (P = not significant).

CONCLUSIONS

Laparoscopic Heller myotomy is highly effective at palliating the symptoms of achalasia. With time, symptoms may recur owing to esophageal dysmotility, mandating continued surveillance.

摘要

背景

我们试图评估腹腔镜下贲门肌切开术后患者症状如何演变。

方法

在腹腔镜下贲门肌切开术前和术后，88例患者按照李克特量表（0 =无；5 =严重）对吞咽困难和烧心进行分级。患者将结果评为优、良、中或差。在1年和3年随访时对同一批患者的结果进行比较。

结果

在早期随访（10.6±7.8个月）时，吞咽困难（11%对100%）、吞咽困难评分（0.6±1.1对4.7±0.7）、烧心（31%对72%）及烧心评分（1.2±1.6对2.7±1.9）均显著降低。到晚期随访（37.6个月±18.0）时，这些数值有所上升（分别为47%、1.9±1.7、48%、1.8±1.5），但与手术前相比仍显著降低。早期和晚期随访时优/良结果分别为89%和85%（P =无显著性差异）。