Ross Samuel W, Oommen Bindhu, Wormer Blair A, Walters Amanda L, Matthews Brent D, Heniford B T, Augenstein Vedra A
Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA.
Surg Endosc. 2015 Nov;29(11):3097-105. doi: 10.1007/s00464-014-4054-0. Epub 2015 Jan 15.
Laparoscopic Heller myotomy (LHM) has supplanted an open approach due to decreased operative morbidity. Our goal was to quantify the incidence of peri-operative complications and identify risk factors for adverse outcomes in LHM.
All LHM were queried from 2005 to 2011 from the National Surgical Quality Improvement Program database. Adverse outcomes were identified, and univariate and stepwise logistic regression (MVR) was then performed to quantify association.
There were 1,237 LHM in the study period. Patient averages were: age 51.9 ± 16.8 years, BMI 27.3 ± 6.6 kg/m(2), Charlson comorbidity index (CCI) 0.2 ± 0.6. 15.3 % had >10 % body mass loss in the preoperative 6 months. During surgery, 10.2 % underwent concomitant EGD, and mean operative time was 141.6 ± 63.4 min. There were 7(0.06 %) wound complications, 22(1.8 %) general complications, and 30(2.4 %) major complications. Average length of stay (LOS) was 2.8 ± 5.5 days. The rate of readmission and reoperation were 3.1 and 2.3 %, respectively, and there were 4(0.03 %) deaths. General and major complications were associated with alcohol use, pack-years of smoking, weight loss, history of stroke, radiation therapy, and longer operative times (p < 0.05); however, these factors did not remain significant on MVR (p > 0.05). Operative time was found to be significantly longer by 35.3 min for inpatients, 43.1 min in functionally dependent patients, 50.0 min in preoperative septic patients, and 17.2 min with concomitant EGD (p < 0.01 for all). LOS was found to be longer by 1.9 days for inpatients, 1.8 days in ASA category ≥3, and 1.2 days per one point increase in CCI (p < 0.001 for all).
LHM is being performed nationally with a low incidence of operative complications and mortality. General and major complications following LHM are associated with patient alcohol use, pack-years of smoking, weight loss, history of stroke, radiation therapy, and longer operative times. Additionally, independent predictors of longer operative time and LOS were identified.
由于手术发病率降低，腹腔镜下食管下段肌层切开术（LHM）已取代开放手术方法。我们的目标是量化围手术期并发症的发生率，并确定LHM不良结局的风险因素。
从国家外科质量改进计划数据库中查询2005年至2011年期间所有的LHM手术。确定不良结局，然后进行单因素和逐步逻辑回归（MVR）以量化相关性。
研究期间共有1237例LHM手术。患者平均情况如下：年龄51.9±16.8岁，体重指数（BMI）27.3±6.6kg/m²，查尔森合并症指数（CCI）0.2±0.6。15.3%的患者在术前6个月体重减轻超过10%。手术期间，10.2%的患者同时接受了上消化道内镜检查（EGD），平均手术时间为141.6±63.4分钟。有7例（0.06%）伤口并发症，22例（1.8%）一般并发症，30例（2.4%）严重并发症。平均住院时间（LOS）为2.8±5.5天。再入院率和再次手术率分别为3.1%和2.3%，有4例（0.03%）死亡。一般并发症和严重并发症与饮酒、吸烟包年数、体重减轻、中风病史、放射治疗以及手术时间较长有关（p<0.05）；然而，这些因素在MVR分析中并不显著（p>0.05）。发现住院患者的手术时间显著延长35.3分钟，功能依赖患者延长43.1分钟，术前感染患者延长50.0分钟，同时接受EGD检查的患者延长17.2分钟（所有p<0.01）。发现住院患者的LOS延长1.9天，美国麻醉医师协会（ASA）分级≥3的患者延长1.8天，CCI每增加1分LOS延长1.2天（所有p<0.001）。
全国范围内开展的LHM手术，手术并发症和死亡率发生率较低。LHM术后的一般并发症和严重并发症与患者饮酒、吸烟包年数、体重减轻、中风病史、放射治疗以及手术时间较长有关。此外，还确定了手术时间延长和LOS延长的独立预测因素。
