Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
J Gastrointest Surg. 2009 Dec;13(12):2095-103. doi: 10.1007/s11605-009-1049-6. Epub 2009 Sep 30.
The effect of preoperative pneumatic dilation or botulinum toxin injection on outcomes after laparoscopic Heller myotomy (LHM) for achalasia is unclear. We compared outcomes in patients with and without multiple preoperative endoscopic interventions.
This cohort study categorized achalasia patients undergoing first-time LHM by the number of preoperative endoscopic interventions: zero or one intervention vs. two or more interventions. Outcomes of interest included surgical failure (defined as the need for re-intervention), gastrointestinal symptoms, and health-related quality of life. Logistic regression modeling was performed to determine the independent effect of multiple preoperative endoscopic interventions on the likelihood of surgical failure.
One hundred thirty-four patients were included; 88 (66%) had zero to one preoperative intervention, and 46 (34%) had multiple (more than one) interventions. The incidence of surgical failure was 7% in the zero to one intervention group and 28% in the more than one intervention group (p < 0.01). Greater improvements in gastrointestinal symptoms and health-related quality of life were seen in the zero to one intervention group. On logistic regression modeling, the likelihood of surgical failure was significantly higher in the more than one intervention group (odds ratio = 5.1, 95% confidence interval 1.6-15.8, p = 0.005).
Multiple endoscopic treatments are associated with poorer outcomes and should be limited to achalasia patients who fail surgical therapy.
术前气动扩张或肉毒毒素注射对贲门失弛缓症腹腔镜 Heller 肌切开术（LHM）后结局的影响尚不清楚。我们比较了接受多次术前内镜介入治疗和未接受多次术前内镜介入治疗的患者的结局。
这项队列研究根据术前内镜介入的次数将接受首次 LHM 的贲门失弛缓症患者分为两组：零次或一次介入与两次或更多次介入。主要观察终点包括手术失败（定义为需要再次干预）、胃肠道症状和健康相关生活质量。采用逻辑回归模型确定多次术前内镜介入对手术失败可能性的独立影响。
共纳入 134 例患者；88 例（66%）接受零至一次术前干预，46 例（34%）接受两次或更多次干预。零至一次干预组的手术失败发生率为 7%，两次或更多次干预组为 28%（p < 0.01）。零至一次干预组的胃肠道症状和健康相关生活质量改善更明显。逻辑回归模型显示，多次干预组手术失败的可能性显著更高（比值比=5.1，95%置信区间 1.6-15.8，p=0.005）。
多次内镜治疗与较差的结局相关，应仅限于手术治疗失败的贲门失弛缓症患者。
