Asti Emanuele, Sironi Andrea, Lovece Andrea, Bonavina Giulia, Fanelli Melania, Bonitta Gianluca, Bonavina Luigi
Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milano, Italy.
Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milano, Italy.
Surgery. 2017 Apr;161(4):977-983. doi: 10.1016/j.surg.2016.10.023. Epub 2016 Dec 20.
In addition to symptom scores, a person's perception of health and quality of life assessment is an important indicator of quality of treatment and can provide an efficient index to compare different therapeutic modalities in chronic disease states. Only a few studies have investigated quality of life comprehensively in patients with achalasia, and therefore the controversy regarding the best treatment algorithm continues. The primary study outcome was pre- and postoperative quality of life in patients with achalasia undergoing laparoscopic Heller myotomy and Dor fundoplication.
The study is a retrospective, observational cohort. The hospital registry and the updated research database were reviewed to identify all patients who were treated for achalasia between 2010 and 2015. Patients were eligible for the study if they had a minimum 1-year follow-up and had pre-and postoperative Eckardt, Short Form-36, and Gastro-Esophageal Reflux Disease Health-Related Quality of Life scores. Patients with previous operative and/or endoscopic treatments for achalasia were excluded.
One-hundred and eighteen patients were identified. The median follow-up was 40 months (interquartile range 27). The proportion of patients with Eckardt stage II-III decreased from 94.9-13% (P < .001). The mean Eckardt score decreased from 6.9 ± 1.9 to 1.7 ± 1.2 (P < .001); the mean Short Form-36 scores significantly increased in all 8 domains; the mean Gastro-Esophageal Reflux Disease Health-Related Quality of Life score decreased from 13.9 ± 5.7 to 5.5 ± 5.4 (P < .001). Finally, 88% (confidence interval 81-93) of patients were satisfied regarding their present condition.
Quality of life assessed with generic and disease-specific validated instruments significantly improved after laparoscopic Heller myotomy combined with Dor fundoplication.
除症状评分外，患者对健康的认知和生活质量评估是治疗质量的重要指标，可为比较慢性病状态下不同治疗方式提供有效指标。仅有少数研究全面调查了贲门失弛缓症患者的生活质量，因此关于最佳治疗方案的争议仍在继续。主要研究结果是接受腹腔镜海勒肌切开术和Dor胃底折叠术的贲门失弛缓症患者术前和术后的生活质量。
本研究为回顾性观察队列研究。查阅医院登记资料和更新后的研究数据库，以确定2010年至2015年间所有接受贲门失弛缓症治疗的患者。如果患者至少有1年的随访时间，并且有术前和术后的埃卡德特评分、简明健康状况调查量表（Short Form-36）评分以及胃食管反流病健康相关生活质量评分，则符合研究条件。既往接受过贲门失弛缓症手术和/或内镜治疗的患者被排除。
共确定了118例患者。中位随访时间为40个月（四分位间距为27个月）。埃卡德特Ⅱ - Ⅲ期患者的比例从94.9%降至13%（P <.001）。埃卡德特评分的平均值从6.9 ± 1.9降至1.7 ± 1.2（P <.001）；简明健康状况调查量表的所有8个领域的平均评分均显著提高；胃食管反流病健康相关生活质量评分的平均值从13.9 ± 5.7降至5.5 ± 5.4（P <.001）。最后，88%（置信区间81 - 93）的患者对其当前状况感到满意。
采用通用和疾病特异性有效工具评估的生活质量在腹腔镜海勒肌切开术联合Dor胃底折叠术后显著改善。
