Tsuboi Kazuto, Omura Nobuo, Yano Fumiaki, Hoshino Masato, Yamamoto Se-Ryung, Akimoto Shusuke, Masuda Takahiro, Kashiwagi Hideyuki, Yanaga Katsuhiko
Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan.
Surg Endosc. 2016 Feb;30(2):706-714. doi: 10.1007/s00464-015-4264-0. Epub 2015 Jun 20.
Mucosal injury during myotomy is the most frequent complication seen with the Heller-Dor procedure for achalasia. The present study aimed to examine risk factors for such mucosal injury during this procedure.
This was a retrospective analysis of patients who underwent the laparoscopic Heller-Dor procedure for achalasia at a single facility. Variables for evaluation included patient characteristics, preoperative pathophysiological findings, and surgeon's operative experience. Logistic regression was used to identify risk factors. We also examined surgical outcomes and the degree of patient satisfaction in relation to intraoperative mucosal injury.
Four hundred thirty-five patients satisfied study criteria. Intraoperative mucosal injury occurred in 67 patients (15.4%). In univariate analysis, mucosal injury was significantly associated with the patient age ≥60 years, disease history ≥10 years, prior history of cardiac diseases, preoperative esophageal transverse diameter ≥80 mm, and surgeon's operative experience with fewer than five cases. In multivariate analysis involving these factors, the following variables were identified as risk factors: age ≥60 years, esophageal transverse diameter ≥80 mm, and surgeon's operative experience with fewer than five cases. The mucosal injury group had significant extension of the operative time and increased blood loss. However, there were no significant differences between the two groups in the incidence of reflux esophagitis or the degree of symptom alleviation postoperatively.
The fragile esophagus caused by advanced patient age and/or dilatation were risk factor for mucosal injury during laparoscopic Heller-Dor procedure. And novice surgeon was also identified as an isolated risk factor for mucosal injury.
在贲门失弛缓症的Heller-Dor手术中，肌切开术期间的黏膜损伤是最常见的并发症。本研究旨在探讨该手术过程中发生这种黏膜损伤的危险因素。
这是一项对在单一机构接受腹腔镜Heller-Dor手术治疗贲门失弛缓症患者的回顾性分析。评估变量包括患者特征、术前病理生理结果和外科医生的手术经验。采用逻辑回归分析来确定危险因素。我们还研究了与术中黏膜损伤相关的手术结果和患者满意度。
435例患者符合研究标准。67例患者（15.4%）发生术中黏膜损伤。单因素分析中，黏膜损伤与患者年龄≥60岁、病程≥10年、有心脏病史、术前食管横径≥80mm以及外科医生手术经验少于5例显著相关。在对这些因素进行多因素分析时，确定了以下变量为危险因素：年龄≥60岁、食管横径≥80mm以及外科医生手术经验少于5例。黏膜损伤组手术时间显著延长，失血量增加。然而，两组在反流性食管炎发生率或术后症状缓解程度方面无显著差异。
高龄患者和/或食管扩张导致的食管脆弱是腹腔镜Heller-Dor手术中黏膜损伤的危险因素。新手外科医生也被确定为黏膜损伤的一个独立危险因素。
