Carter Jonathan T, Nguyen Dennis, Roll Garrett R, Ma Sandi W, Way Lawrence W
Department of Surgery, University of California, San Francisco, San Francisco, CA 94143-0790, USA.
Arch Surg. 2011 Sep;146(9):1024-8. doi: 10.1001/archsurg.2011.214.
To identify predictors of long-term outcome of laparoscopic Heller myotomy for achalasia, including predictors of heartburn and recurrent dysphagia, which occasionally develop postoperatively.
Retrospective review using interviews of patients.
Academic university hospital.
One hundred sixty-five patients with achalasia who underwent a laparoscopic esophagomyotomy and Dor fundoplication.
Dysphagia and heartburn before and after the operation were assessed on a 4-point Likert scale, as were postoperative dilations, reoperations, and antacid use. Potential predictors were age, race, sex, body mass index, weight loss, duration of symptoms, manometry findings, esophageal diameter, previous treatment, and operative technique.
Follow-up averaged 62 (range, 1-174) months. Dysphagia frequency was once a week or less in 128 patients (78%), several times per week in 25 (15%), and daily in 12 (7%). Satisfaction scores averaged 3.7 on a 4-point scale. Thirty patients (18%) required a postoperative dilation, and 6 (4%) underwent another operation. The only predictor of postoperative dysphagia was duration of symptoms longer than 10 years (odds ratio, 0.2; P = .03). Preoperative dilations predicted the need for postoperative dilations (odds ratio, 2.4; P = .03). Only 20 patients (12%) reported heartburn more than once weekly, although 75 (45%) reported taking antacids. No variable predicted postoperative heartburn or antacid use.
Long-term outcomes after laparoscopic esophagomyotomy were excellent across a wide spectrum of disease severity and presentations. Previous treatments, such as balloon dilation or botulinum toxin (Botox) injection, did not portend worse outcomes. When the myotomy was extended 2 cm onto the stomach and a Dor fundoplication was performed, severe heartburn was rare.
确定贲门失弛缓症腹腔镜Heller肌切开术长期预后的预测因素，包括烧心和复发性吞咽困难的预测因素，这些情况偶尔会在术后出现。
通过对患者进行访谈进行回顾性研究。
大学附属医院。
165例接受腹腔镜食管肌切开术和Dor胃底折叠术的贲门失弛缓症患者。
采用4级李克特量表评估手术前后的吞咽困难和烧心情况，以及术后扩张、再次手术和使用抗酸剂的情况。潜在的预测因素包括年龄、种族、性别、体重指数、体重减轻、症状持续时间、测压结果、食管直径、既往治疗和手术技术。
随访平均62（范围1 - 174）个月。128例患者（78%）吞咽困难频率为每周一次或更少，25例（15%）为每周几次，12例（7%）为每天发生。满意度评分在4分制量表上平均为3.7分。30例患者（18%）需要术后扩张，6例（4%）接受了再次手术。术后吞咽困难的唯一预测因素是症状持续时间超过10年（比值比，0.2；P = .03）。术前扩张可预测术后扩张的需求（比值比，2.4；P = .03）。只有20例患者（12%）报告烧心每周超过一次，尽管75例（45%）报告使用抗酸剂。没有变量可预测术后烧心或抗酸剂的使用情况。
腹腔镜食管肌切开术后的长期预后在广泛的疾病严重程度和表现范围内都非常好。既往治疗，如球囊扩张或肉毒杆菌毒素（Botox）注射，并不预示着更差的预后。当肌切开术延伸至胃2 cm并进行Dor胃底折叠术时，严重烧心很少见。
