Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
Division of Thoracic Surgery, Maria Cecilia Hospital, Cotignola, Italy.
Ann Thorac Surg. 2022 Jan;113(1):271-278. doi: 10.1016/j.athoracsur.2020.12.048. Epub 2021 Jan 27.
Therapy for end-stage achalasia is debated, and data on long-term functional results of myotomy and esophagectomy are lacking. We compared quality of life and objective outcomes after pull-down Heller-Dor and esophagectomy.
The study included 32 patients, aged 57 years (interquartile range [IQR], 49-70 years), who underwent the Heller-Dor operation with verticalization of the distal esophagus in case of first instance treatment or failed surgery caused by insufficient myotomy, and 16 patients, aged 58 years (IQR, 49-67 years; P = .806), who underwent esophagectomy after failed surgery for other causes. Data were extracted from a database designed for prospective clinical research. Postoperative dysphagia, reflux symptoms, and endoscopic esophagitis were graded by semiquantitative scales. Quality of life was assessed with the 36-Item Short Form Health Survey questionnaire.
The median follow-up period was 68 months (IQR, 40.43-94.48 months) after pull-down Heller-Dor and 61 months (IQR 43.72-181.43 months) after esophagectomy (P = .598). No statistically significant differences were observed for dysphagia (P = .948), reflux symptoms (P = .186), or esophagitis (P = .253). No statistically significant differences were observed in the domains physical functioning (P = .092), bodily pain (P = .075) or general health (P = .453). Significant differences were observed in favor of pull-down Heller-Dor for the domains role physical (100 vs 100, P = .043), role emotional (100 vs 0, P = .002), vitality (90 vs 55, P< .001), mental health (92 vs 68, P = .002), and social functioning (100 v s75, P = .011).
The pull-down Heller-Dor achieved objective results similar to those of esophagectomy with a better quality of life. This technique may be the first choice for end-stage achalasia in patients with null or low risk for cancer or after recurrent dysphagia caused by insufficient myotomy.
对于贲门失弛缓症的终末期治疗存在争议，且缺乏关于肌切开术和食管切除术长期功能结果的数据。我们比较了下拉式 Heller-Dor 手术和食管切除术的生活质量和客观结果。
该研究纳入了 32 名患者，年龄 57 岁（四分位距 [IQR]，49-70 岁），他们接受了 Heller-Dor 手术，如果初次治疗或因肌切开术不足而导致手术失败，则垂直化远端食管，如果因其他原因导致手术失败，则进行食管切除术。数据取自一个为前瞻性临床研究设计的数据库。术后吞咽困难、反流症状和内镜食管炎通过半定量量表进行分级。采用 36 项简短健康调查问卷评估生活质量。
下拉式 Heller-Dor 术后中位随访时间为 68 个月（IQR，40.43-94.48 个月），食管切除术为 61 个月（IQR，43.72-181.43 个月）（P=.598）。吞咽困难（P=.948）、反流症状（P=.186）或食管炎（P=.253）无统计学差异。在身体功能（P=.092）、躯体疼痛（P=.075）或一般健康（P=.453）方面无统计学差异。下拉式 Heller-Dor 在生理职能（100 比 100，P=.043）、情感职能（100 比 0，P=.002）、活力（90 比 55，P<0.001）、心理健康（92 比 68，P=.002）和社会功能（100 比 75，P=.011）方面具有统计学优势。
下拉式 Heller-Dor 取得了与食管切除术相似的客观结果，生活质量更好。在癌症风险为零或低或因肌切开术不足导致复发性吞咽困难的患者中，该技术可能是贲门失弛缓症终末期的首选治疗方法。
