Alma Mater Studiorum, University of Bologna, Bologna.
Division of Thoracic Surgery, Maria Cecilia Hospital, Cotignola.
Ann Surg. 2023 Jul 1;278(1):e27-e34. doi: 10.1097/SLA.0000000000005677. Epub 2022 Sep 9.
To provide information on long-term outcomes of Heller myotomy for esophageal achalasia with or without an antireflux fundoplication.
Since the adoption of the Heller myotomy, surgeons have modified the original technique in order to balance the cure of dysphagia and the consequent cardial incontinence.
Totally, 470 patients underwent primary Heller myotomy between 1955 and 2020. A long abdominal myotomy (AM) was performed in 83 patients, the Ellis limited transthoracic myotomy (TM) in 30, the laparotomic Heller-Dor (L-HD) in 202, the videolaparoscopic Heller-Dor (VL-HD) in 155. The HD was performed under intraoperative manometric assessment. Starting on 1973 these patients underwent a prospective follow-up program of timed lifelong clinical, radiological, endoscopic evaluations.
Median follow-up time was 23.06 years [interquantile range (IQR): 15.04-32.06] for AM, 29.22 years (IQR: 13.46-40.17) for TM, 14.85 years (IQR: 11.05-21.56) for L-HD and 7.51 years (IQR: 3.25-9.60) for VL-HD. In AM, relapse of dysphagia occurred in 25/71 (35.21%), in TM in 11/30 (36.66%), in LH-D in 10/201 (4.97%), in VL-HD in 3/155 (1.93%). Erosive-ulcerative esophagitis was diagnosed for AM in 28.16%, for TM in 30%, for L-HD in 8.45%, for VL-HD in 2.58%. Overall, the outcome was satisfactory in 52.11% for AM, 41.9% for TM, 89.05% for L-HD, 96.12% for VL-HD.
The Dor fundoplication drastically reduces postmyotomy gastroesophageal reflux. The Heller-Dor operation is a competitive option for the cure of esophageal achalasia if this operation is performed according to the rules of surgical physiology learned by means of intraoperative manometry.
提供食管失弛缓症行 Heller 肌切开术（有或无抗反流胃底折叠术）的长期结果信息。
自 Heller 肌切开术应用以来，为了平衡吞咽困难的治愈和随之而来的贲门失弛缓，外科医生对原始技术进行了修改。
1955 年至 2020 年间，共有 470 例患者接受了原发性 Heller 肌切开术。83 例患者行长段腹段肌切开术（AM），30 例患者行 Ellis 有限经胸肌切开术（TM），202 例患者行腹腔镜 Heller-Dor 术（L-HD），155 例患者行腹腔镜 Heller-Dor 术（VL-HD）。HD 术在术中测压评估下进行。自 1973 年起，这些患者接受了终生临床、放射学和内镜评估的前瞻性随访计划。
AM 的中位随访时间为 23.06 年（IQR：15.04-32.06），TM 为 29.22 年（IQR：13.46-40.17），L-HD 为 14.85 年（IQR：11.05-21.56），VL-HD 为 7.51 年（IQR：3.25-9.60）。在 AM 中，25/71（35.21%）例出现吞咽困难复发，TM 中 11/30（36.66%）例，L-HD 中 10/201（4.97%）例，VL-HD 中 3/155（1.93%）例。AM 中诊断为腐蚀性溃疡性食管炎 28.16%，TM 中诊断为 30%，L-HD 中诊断为 8.45%，VL-HD 中诊断为 2.58%。总的来说，AM 的结果令人满意的占 52.11%，TM 为 41.9%，L-HD 为 89.05%，VL-HD 为 96.12%。
Dor 胃底折叠术可显著降低肌切开术后胃食管反流。如果根据术中测压所学到的手术生理学规则进行操作，Heller-Dor 手术是治疗食管失弛缓症的一种有竞争力的选择。
