Division of Thoracic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada.
Ann Thorac Surg. 2010 Feb;89(2):392-6. doi: 10.1016/j.athoracsur.2009.10.046.
Our objective is to ascertain if preoperative and perioperative treatments affect the short- and long-term symptom frequency or symptom scores for dysphagia, regurgitation, and heartburn in patients with laparoscopic Heller myotomy for achalasia.
From 1994 to 2008, 261 patients undergoing laparoscopic esophageal myotomy were enrolled prospectively. The diagnosis of classic achalasia was made on clinical history, barium swallow, endoscopy, and manometry. A validated symptom questionnaire and history was taken for each patient at the preoperative visit and at each postoperative visit.
In all, 261 patients had laparoscopic Heller myotomy during the study period. Preoperatively, 137 patients (62.3%) tried medications, 101 (38.7%) were treated with pneumatic dilation, and 29 (11.1%) were treated initially with at least one injection of botulinum toxin into the lower esophageal sphincter. In all, 134 patients (51.3%) received a Dor anterior fundoplication. On multivariate regression controlling for age and sex, preoperative dilation (p = 0.031), injection of botulinum toxin (p = 0.044), and a fundoplication (p = 0.005) were associated with significantly worse early postoperative dysphagia, with odds ratios of 2.11, 2.56, and 2.80, respectively; previous botulinum toxin injection was associated with worse late postoperative dysphagia (p = 0.001), regurgitation (p = 0.031), and heartburn (p = 0.049), with odds ratios of 5.24, 2.87, and 2.52, respectively. There was a trend for no fundoplication to be associated with late postoperative heartburn (p = 0.077) with an odds ratio of 1.80.
Many patients presenting for Heller myotomy have previously undergone a different form of treatment. Early postoperative dysphagia was affected by dilation, botulinum toxin injection, and fundoplication. Only botulinum toxin injection was associated with late symptoms.
我们的目的是确定术前和围手术期治疗是否会影响腹腔镜 Heller 肌切开术治疗贲门失弛缓症患者的短期和长期吞咽困难、反流和烧心症状频率或评分。
1994 年至 2008 年，前瞻性纳入 261 例行腹腔镜食管肌切开术的患者。根据临床病史、钡餐、内镜和测压术诊断为经典贲门失弛缓症。每位患者在术前就诊和每次术后就诊时均接受了经过验证的症状问卷和病史。
研究期间，共有 261 例患者行腹腔镜 Heller 肌切开术。术前，137 例（62.3%）患者尝试过药物治疗，101 例（38.7%）患者接受过气囊扩张治疗，29 例（11.1%）患者最初接受过至少一次贲门下括约肌肉毒毒素注射治疗。共有 134 例（51.3%）患者接受了 Dor 前胃底折叠术。多变量回归分析控制年龄和性别因素后，术前扩张（p=0.031）、肉毒毒素注射（p=0.044）和胃底折叠术（p=0.005）与术后早期吞咽困难明显相关，优势比分别为 2.11、2.56 和 2.80；先前的肉毒毒素注射与术后晚期吞咽困难（p=0.001）、反流（p=0.031）和烧心（p=0.049）明显相关，优势比分别为 5.24、2.87 和 2.52。无胃底折叠术与晚期术后烧心（p=0.077）呈趋势相关，优势比为 1.80。
许多接受 Heller 肌切开术的患者之前曾接受过不同形式的治疗。早期术后吞咽困难受扩张、肉毒毒素注射和胃底折叠术的影响。只有肉毒毒素注射与晚期症状相关。
