Rosemurgy Alexander, Downs Darrell, Luberice Kenneth, Rodriguez Christian, Swaid Forat, Patel Krishen, Toomey Paul, Ross Sharona
Florida Hospital Tampa, Tampa, Florida, USA.
Am Surg. 2018 Feb 1;84(2):165-173.
This study was undertaken to determine whether postoperative outcomes after laparoscopic Heller myotomy with anterior fundoplication could be predicted by preoperative findings on esophagography. Preoperative barium esophagograms of 135 patients undergoing laparoscopic Heller myotomy with anterior fundoplication were reviewed. The number of esophageal curves, esophageal width, and angulation of the gastroesophageal junction (GEJ) were determined; correlations between these determined parameters and symptoms were assessed using linear regression analysis. The number of esophageal curves correlated with the preoperative frequency of dysphagia, vomiting, chest pain, regurgitation, and heartburn. The width of the esophagus negatively correlated with the preoperative frequency of regurgitation. The angulation of the GEJ did not correlate with preoperative symptoms. Laparoscopic Heller myotomy with anterior fundoplication significantly reduced the frequency and severity of all symptoms, regardless of the number of esophageal curves, esophageal width, or angulation of the GEJ. Laparoscopic Heller myotomy with anterior fundoplication provides dramatic palliation for achalasia. More esophageal curves on preoperative esophagography correlate well with the frequency of a broad range of preoperative symptoms, including the frequency of dysphagia and regurgitation. Patients experience dramatically improved frequency and severity of symptoms after laparoscopic Heller myotomy with anterior fundoplication for achalasia regardless of the number of esophageal curves, esophageal width, or the angulation of the GEJ. Findings on barium esophagogram, in evaluating achalasia, should not deter the application of laparosocopic Heller myotomy with anterior fundoplication.
本研究旨在确定食管造影的术前检查结果能否预测腹腔镜下贲门肌切开术加前位胃底折叠术的术后结局。回顾了135例行腹腔镜下贲门肌切开术加前位胃底折叠术患者的术前钡剂食管造影。测定食管弯曲数量、食管宽度和胃食管交界（GEJ）的角度；使用线性回归分析评估这些测定参数与症状之间的相关性。食管弯曲数量与术前吞咽困难、呕吐、胸痛、反流和烧心的发生频率相关。食管宽度与术前反流发生频率呈负相关。GEJ的角度与术前症状无关。无论食管弯曲数量、食管宽度或GEJ角度如何，腹腔镜下贲门肌切开术加前位胃底折叠术均能显著降低所有症状的发生频率和严重程度。腹腔镜下贲门肌切开术加前位胃底折叠术可为贲门失弛缓症提供显著缓解。术前食管造影上更多的食管弯曲与包括吞咽困难和反流发生频率在内的一系列术前症状的发生频率密切相关。无论食管弯曲数量、食管宽度或GEJ角度如何，贲门失弛缓症患者行腹腔镜下贲门肌切开术加前位胃底折叠术后症状的发生频率和严重程度均显著改善。在评估贲门失弛缓症时，钡剂食管造影的检查结果不应妨碍腹腔镜下贲门肌切开术加前位胃底折叠术的应用。
