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腹腔镜食管胃肌切开术(Heller-Pinotti 手术)加胃底折叠术治疗非晚期贲门失弛缓症(巨食管)的短期和长期疗效。

SHORT AND LONG-TERM RESULTS OF LAPAROSCOPIC ESOPHAGOCARDIOMYOTOMY WITH FUNDOPLICATION (HELLER-PINOTTI SURGERY) IN THE TREATMENT OF NON-ADVANCED ACHALASIA (MEGAESOPHAGUS).

机构信息

Universidade Federal de Uberlândia, Digestive Surgery Unit - Uberlândia (MG), Brazil.

Faculdade São Leopoldo Mandic, Minimally Invasive Surgery, Master of Medical Sciences - Campinas (SP), Brazil.

出版信息

Arq Bras Cir Dig. 2024 Jun 17;37:e1803. doi: 10.1590/0102-6720202400010e1803. eCollection 2024.


DOI:10.1590/0102-6720202400010e1803
PMID:38896699
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11182623/
Abstract

BACKGROUND: Videolaparoscopic esophagocardiomyotomy with fundoplication has been a widely used technique for the treatment of achalasia. This study analyzes the safety and effectiveness of the technique in the treatment of non-advanced achalasia (megaesophagus) in a Brazilian federal university public hospital. AIMS: To evaluate the short- and long-term results of videolaparoscopic treatment of non-advanced megaesophagus in a public university hospital in Brazil, employing the esophagocardiomyotomy technique with fundoplication. METHODS: The medical records of 44 patients who underwent surgical treatment for non-advanced achalasia at the Clinical Hospital of Federal University of Uberlândia (UFU-MG), Minas Gerais, from January 2001 to July 2021 were analyzed. The following data were evaluated: gender, age, etiology, radiological classification of Rezende-Alves and Ferreira-Santos, immediate and late complications (mean follow-up of 31.4 months), need or not for conversion to open access, postoperative reflux, performance or not of endoscopic esophageal dilation in the preoperative period, postoperative mortality, frequency of pre and postoperative symptoms (persistent dysphagia, regurgitation, heartburn, vomiting, odynophagia, and weight loss), surgery time, hospital stay, duration of dysphagia, pre and postoperative weight, and Eckardt score. RESULTS: Among the analyzed patients, 23 (52.3%) were male, and 21 (47.7%) were female, with a mean age of 50.8 years. No early complications were recorded and there were 27.2% cases of late gastroesophageal reflux. Postoperative weight gain was 81.8% and the success rate of surgery according to the Eckardt score was 84.1%. CONCLUSIONS: Esophagocardiomyotomy with fundoplication is an effective and safe technique for the treatment of non-advanced achalasia.

摘要

背景:经视频腹腔镜食管裂孔肌切开术加胃底折叠术已广泛用于治疗贲门失弛缓症。本研究分析了该技术在巴西联邦大学公立医院治疗非晚期贲门失弛缓症(巨食管症)的安全性和有效性。

目的:评估经视频腹腔镜治疗巴西联邦大学公立医院非晚期巨食管症的短期和长期结果,采用食管裂孔肌切开术加胃底折叠术。

方法:分析了 2001 年 1 月至 2021 年 7 月,在米纳斯吉拉斯州联邦大学 Uberlândia 临床医院(UFU-MG)接受非晚期贲门失弛缓症手术治疗的 44 例患者的病历。评估以下数据:性别、年龄、病因、Rezende-Alves 和 Ferreira-Santos 的放射学分类、即刻和迟发性并发症(平均随访 31.4 个月)、是否需要转为开放通道、术后反流、术前是否进行内镜食管扩张、术后死亡率、术前和术后症状(持续性吞咽困难、反流、烧心、呕吐、吞咽困难和体重减轻)的频率、手术时间、住院时间、吞咽困难持续时间、术前和术后体重以及 Eckardt 评分。

结果:在分析的患者中,23 例(52.3%)为男性,21 例(47.7%)为女性,平均年龄为 50.8 岁。无早期并发症,晚期胃食管反流发生率为 27.2%。术后体重增加 81.8%,根据 Eckardt 评分手术成功率为 84.1%。

结论:食管裂孔肌切开术加胃底折叠术是治疗非晚期贲门失弛缓症的有效且安全的技术。

相似文献

[1]
SHORT AND LONG-TERM RESULTS OF LAPAROSCOPIC ESOPHAGOCARDIOMYOTOMY WITH FUNDOPLICATION (HELLER-PINOTTI SURGERY) IN THE TREATMENT OF NON-ADVANCED ACHALASIA (MEGAESOPHAGUS).

Arq Bras Cir Dig. 2024

[2]
Effects of preoperative endoscopic pneumatic balloon dilatation on postoperative achalasia symptoms after Heller esophageal myotomy plus Dor fundoplication.

Turk J Gastroenterol. 2018-9

[3]
Effects of Anterior Fundoplication on Postoperative Dysphagia and Reflux After Laparoscopic Esophagocardiomyotomy for Pediatric Achalasia.

J Laparoendosc Adv Surg Tech A. 2024-6

[4]
[Effectiveness of laparoscopic esophagocardiomyotomy combined with various modifications of fundoplication in the treatment of achalasia cardia].

Khirurgiia (Mosk). 2022

[5]
Mucosal perforation during laparoscopic surgery for achalasia: impact of preoperative pneumatic balloon dilation.

Surg Endosc. 2017-3

[6]
Laparoscopic heller myotomy and anterior fundoplication for achalasia results in a high degree of patient satisfaction.

Arch Surg. 2000-8

[7]
[Late results of Heller operation and fundoplication for the treatment of the megaesophagus: analysis of 83 cases].

Rev Assoc Med Bras (1992). 1999

[8]
A total fundoplication is not an obstacle to esophageal emptying after heller myotomy for achalasia: results of a long-term follow up.

Ann Surg. 2005-4

[9]
Surgical management of esophageal achalasia: Evolution of an institutional approach to minimally invasive repair.

J Pediatr Surg. 2016-10

[10]
Comparison of the Heller-Toupet procedure with the Heller-Dor procedure in patients who underwent laparoscopic surgery for achalasia.

Surg Today. 2013-6-22

本文引用的文献

[1]
PERORAL ENDOSCOPIC MYOTOMY FOR ACHALASIA: SAFETY PROFILE, COMPLICATIONS AND RESULTS OF 94 PATIENTS.

Arq Bras Cir Dig. 2023

[2]
MANAGEMENT OF SYMPTOMS RECURRENCE AFTER MYOTOMY FOR ACHALASIA. A PRACTICAL APPROACH.

Arq Bras Cir Dig. 2023

[3]
Peroral endoscopic myotomy laparoscopic myotomy and partial fundoplication for esophageal achalasia: A single-center randomized controlled trial.

World J Gastroenterol. 2022-9-7

[4]
Outcomes of 100 Patients More Than 4 Years After POEM for Achalasia.

Ann Surg. 2021-6-1

[5]
Long-term (17 years) subjective and objective evaluation of the durability of laparoscopic Heller esophagomyotomy in patients with achalasia of the esophagus (90% of follow-up): a real challenge to POEM.

Surg Endosc. 2022-1

[6]
ACG Clinical Guidelines: Diagnosis and Management of Achalasia.

Am J Gastroenterol. 2020-9

[7]
Surgery Outcomes and Quality of Life in Achalasia's Treatment.

J Laparoendosc Adv Surg Tech A. 2020-12

[8]
Achalasia: what to do in the face of failures of Heller myotomy.

Ann N Y Acad Sci. 2020-7-26

[9]
Surgical treatment of relapsed megaesophagus.

Rev Col Bras Cir. 2020-6-8

[10]
Outcomes of Laparoscopic Heller Myotomy for Achalasia: 22-Year Experience.

J Gastrointest Surg. 2020-6

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