Tsuboi Kazuto, Omura Nobuo, Yano Fumiaki, Hoshino Masato, Yamamoto Se-Ryung, Akimoto Shunsuke, 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.
Esophagus. 2018 Jan;15(1):39-46. doi: 10.1007/s10388-017-0593-5. Epub 2017 Sep 18.
Balloon dilatation is reportedly less effective for young patients with esophageal achalasia than for older patients. However, there is no consensus on the impact of prior balloon dilatation on outcomes of surgical treatment. This study investigated the significance of preoperative balloon dilatation on surgical outcomes in young patients with esophageal achalasia.
Of patients aged less than 40 years who had undergone a laparoscopic Heller-Dor operation for esophageal achalasia, 201 with a postoperative follow-up period of at least 1 year were included. They were divided into two groups with and without a history of balloon dilatation, and compared preoperative pathological conditions and surgical outcomes.
This study included 100 men and 101 women with a median age of 31 years, of whom 158 patients without a history of pneumatic dilatation (79%, non-PD group) and 43 with a history of pneumatic dilatation (21%, PD group) The preoperative symptom scores for dysphagia and regurgitation were significantly higher in the non-PD group. Although no differences were observed in surgical outcomes or postoperative course, the esophageal clearance rates calculated on preoperative and postoperative timed barium esophagograms were lower in terms of both height and width of the barium column in the PD group than in the non-PD group. Subjectively, both groups expressed equally high satisfaction.
In patients aged less than 40 years with esophageal achalasia, although preoperative balloon dilatation did not affect subjective levels of satisfaction with surgery, postoperative improvement in esophageal clearance in the lower esophagus was inhibited.
据报道，球囊扩张术对年轻的食管贲门失弛缓症患者的疗效不如老年患者。然而，关于先前球囊扩张术对手术治疗结果的影响尚无共识。本研究调查了术前球囊扩张术对年轻食管贲门失弛缓症患者手术结果的意义。
纳入年龄小于40岁、接受过腹腔镜Heller-Dor手术治疗食管贲门失弛缓症且术后随访期至少1年的患者。将他们分为有球囊扩张史和无球囊扩张史两组，比较术前病理状况和手术结果。
本研究包括100名男性和101名女性，中位年龄为31岁，其中158例无气囊扩张史患者（79%，非PD组）和43例有气囊扩张史患者（21%，PD组）。非PD组术前吞咽困难和反流的症状评分显著更高。虽然手术结果或术后病程没有差异，但PD组术前和术后定时钡剂食管造影计算的食管清除率在钡柱高度和宽度方面均低于非PD组。主观上，两组的满意度都同样高。
在年龄小于40岁的食管贲门失弛缓症患者中，虽然术前球囊扩张术不影响对手术的主观满意度，但会抑制食管下段术后清除功能的改善。
