Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Clinica Chirurgica 3, Policlinico Universitario, 35128, Padua, Italy.
Esophageal and Digestive Tract Surgical Unit, Regional Centre for Esophageal Disease, Veneto Institute of Oncology (IOV IRCCS), Padua, Italy.
Surg Endosc. 2017 Sep;31(9):3510-3518. doi: 10.1007/s00464-016-5377-9. Epub 2016 Dec 30.
Esophageal achalasia can be classified on the grounds of three distinct manometric patterns that correlate well with final outcome after laparoscopic Heller-Dor myotomy (LHM). No analytical data are available, however, on the postoperative picture and its possible correlation with final outcome. The aims of this study were: (a) to investigate whether manometric patterns change after LHM for achalasia; (b) to ascertain whether postoperative patterns and/or changes can predict final outcome; and (c) to test the hypothesis that the three known patterns represent different stages in the evolution of the disease.
During the study period, we prospectively enlisted 206 consecutive achalasia patients who were assessed using high-resolution manometry (HRM) before undergoing LHM. Symptoms were scored using a detailed questionnaire. Barium swallow, endoscopy and HRM were performed, before and again 6 months after surgery.
Preoperative HRM revealed the three known patterns with statistically different esophageal diameters (pattern I having the largest), and patients with pattern I had the highest symptom scores. The surgical treatment failed in 10 cases (4.9%). The only predictor of final outcome was the preoperative manometric pattern (p = 0.01). All patients with pattern I preoperatively had the same pattern afterward, whereas nearly 50% of patients with pattern III before LHM had patterns I or II after surgery. There were no cases showing the opposite trend.
Neither a change of manometric pattern after surgery nor a patient's postoperative pattern was a predictor of final outcome, whereas preoperative pattern confirmed its prognostic significance. The three manometric patterns distinguishable in achalasia may represent different stages in the disease's evolution, pattern III and pattern I coinciding with the early and final stages of the disease, respectively.
食管失弛缓症可根据三种不同的测压模式进行分类，这些模式与腹腔镜 Heller-Dor 肌切开术（LHM）后的最终结果密切相关。然而，尚无关于术后情况及其与最终结果可能的相关性的分析数据。本研究的目的是：（a）探讨失弛缓症患者行 LHM 后测压模式是否发生变化；（b）确定术后模式和/或变化是否可以预测最终结果；（c）验证三种已知模式代表疾病发展不同阶段的假设。
在研究期间，我们前瞻性地招募了 206 例连续的失弛缓症患者，这些患者在接受 LHM 之前均接受了高分辨率测压（HRM）检查。使用详细的问卷对症状进行评分。在手术前和手术后 6 个月分别进行钡餐、内镜和 HRM 检查。
术前 HRM 显示出三种具有统计学差异的食管直径的已知模式（模式 I 最大），且模式 I 的患者症状评分最高。10 例（4.9%）手术治疗失败。最终结果的唯一预测因素是术前测压模式（p=0.01）。所有术前为模式 I 的患者术后均保持相同的模式，而术前为模式 III 的患者中近 50%在 LHM 后表现为模式 I 或 II。没有出现相反的趋势。
手术前后测压模式的变化均不是最终结果的预测因素，而术前模式证实了其预后意义。在失弛缓症中可区分的三种测压模式可能代表疾病演变的不同阶段，模式 III 和模式 I 分别与疾病的早期和晚期相对应。
