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机器人辅助 Heller-Dor 肌切开术治疗贲门失弛缓症的临床和病理生理学结果:单中心经验。

Clinical and pathophysiological outcomes of the robotic-assisted Heller-Dor myotomy for achalasia: a single-center experience.

机构信息

Unit of Esophageal Surgery, Department of Surgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56124, Pisa, Italy.

Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, AOUP, Pisa, Italy.

出版信息

J Robot Surg. 2020 Apr;14(2):331-335. doi: 10.1007/s11701-019-00988-1. Epub 2019 Jun 22.

Abstract

Laparoscopic Heller myotomy and Dor fundoplication is considered a safe and effective treatment for achalasia. Robotic-assisted Heller-Dor procedure (RAHD) has emerged as an alternative approach due to improved visualization and fine motor control. The aim of this prospective study was to evaluate clinical, and functional results of RAHD. We evaluated a group of 66 patients with achalasia that underwent robotic-assisted Heller-Dor operation. Before treatment all patients underwent a diagnostic work-up such as upper endoscopy, esophageal barium swallow and high resolution manometry. The presence of postoperative gastroesophageal reflux disease was diagnosed by impedance and pH monitoring (MII-pH). Dysphagia improved in 92.4% of patients after treatment. Barium swallow series showed esophageal emptying in 100% of patients and a significant reduction of the esophageal diameter (p = 0.00235). Forty-five of 66 patients (68.2%) underwent upper endoscopy and 35 of 66 (53%) underwent MII-pH. Esophageal erosions were found in 4/45 (8,8%) and MII-pH showed abnormal results in 3/35 patients (8.6%). RAHD ensures a meticulous esophageal and gastric myotomy, allowing to visualize and divide each muscle fibers with a low rate of intraoperative and postoperative complications. resulting in turn in good clinical outcomes, radiological findings and functional results even if robotic tecnique definitely increases the surgical cost in the treatment of these functional esophageal disorders.

摘要

腹腔镜 Heller 肌切开术和 Dor 胃底折叠术被认为是治疗贲门失弛缓症的安全有效的方法。由于可视化和精细运动控制的改善,机器人辅助 Heller-Dor 手术(RAHD)已成为一种替代方法。本前瞻性研究旨在评估 RAHD 的临床和功能结果。我们评估了一组 66 例接受机器人辅助 Heller-Dor 手术的贲门失弛缓症患者。在治疗前,所有患者均接受了上消化道内镜、食管钡餐和高分辨率测压等诊断性检查。通过阻抗和 pH 监测(MII-pH)诊断术后胃食管反流病的存在。治疗后 92.4%的患者吞咽困难得到改善。钡餐系列显示 100%的患者食管排空,食管直径显著缩小(p=0.00235)。66 例患者中有 45 例(68.2%)接受了上消化道内镜检查,35 例(53%)接受了 MII-pH 检查。45 例中有 4 例(8.8%)发现食管糜烂,35 例中有 3 例(8.6%)MII-pH 检查结果异常。RAHD 可确保进行精细的食管和胃肌切开术,允许可视化并以低的术中及术后并发症发生率切开每根肌纤维,从而获得良好的临床结果、影像学发现和功能结果,即使机器人技术确实会增加这些功能性食管疾病治疗的手术成本。

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