采用赫勒肌切开术治疗复发性贲门失弛缓症：文献综述
Recurrent achalasia treated with Heller myotomy: a review of the literature.
作者信息
Wang Lan, Li You-Ming
机构信息
The First Affiliated Hospital, Medical College, Zhejiang University, Zhejiang Province, China.
出版信息
World J Gastroenterol. 2008 Dec 14;14(46):7122-6. doi: 10.3748/wjg.14.7122.
Abstract
AIM
To evaluate the efficacy and safety of Heller myotomy (HM) for recurrent achlasia, performed after different methods of first-line treatment.
METHODS
We searched for studies published in PubMed from 1966 to March 2008 on treatment of recurrent achalasia with HM after failure with different methods of first-line treatment. The efficacy of HM was assessed by a pooled estimate of response rate with individual studies weighted proportionally to sample size.
RESULTS
Sixteen studies were eligible and included in the review. The results showed that HM has a better remission rate for recurrent achalasia after failure of HM [weighted mean (SD)] of 86.9% (21.8%) compared with 81.6% (23.8%) for pneumatic dilatation (PD). One study evaluated the efficacy of HM after failure of PD combined with botulinum toxin injection (83%). The most common complications were perforation and gastroesophageal reflux.
CONCLUSION
HM has the best efficacy in patients with recurrent achlasia who were treated with HM as first-line treatment. Future studies should focus on how to increase the success rate and decrease the complications of HM.
摘要
目的
评估在采用不同一线治疗方法后进行的 heller 肌切开术（HM）治疗复发性贲门失弛缓症的疗效和安全性。
方法
我们检索了 1966 年至 2008 年 3 月发表在 PubMed 上的关于在不同一线治疗方法失败后用 HM 治疗复发性贲门失弛缓症的研究。通过对各研究的缓解率进行汇总估计来评估 HM 的疗效，各研究按样本量加权。
结果
16 项研究符合纳入综述的条件。结果显示，与气囊扩张术（PD）的 81.6%（标准差 23.8%）相比，HM 治疗失败后的复发性贲门失弛缓症缓解率[加权均值（标准差）]更高，为 86.9%（21.8%）。一项研究评估了在 PD 联合肉毒杆菌毒素注射失败后 HM 的疗效（83%）。最常见的并发症是穿孔和胃食管反流。
结论
对于以 HM 作为一线治疗的复发性贲门失弛缓症患者，HM 疗效最佳。未来的研究应聚焦于如何提高 HM 的成功率并减少其并发症。
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