Department of General Surgery, Bezmialem Vakif University Faculty of Medicine Hospital, Istanbul-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2024 Nov;30(11):775-779. doi: 10.14744/tjtes.2024.27030.
Achalasia is a rare neurodegenerative disease of the esophagus that causes impaired esophageal peristalsis and the inability of the lower esophageal sphincter (LES) to relax. This results in symptoms such as dysphagia, regurgitation, chest pain, and weight loss. Among the treatment options, Laparoscopic Heller Myotomy (LHM), Endoscopic Balloon Dilation (EBD), and Peroral Endoscopic Myotomy (POEM) are commonly used methods. The aim of this study was to compare the efficacy and clinical long-term results of LHM and EBD in treating achalasia.
Patient records from Bezmialem Vakıf University Hospital were reviewed, and 36 patients diagnosed with achalasia who underwent LHM and EBD were included in the study. Patients were evaluated using the Pre-operative Eckardt Score (Pre-ES) for preoperative evaluation, the Post-operative Eckardt Score (Post-ES) for postoperative evaluation, the Achalasia Specific Quality of Life (ASQL) questionnaire, and the Patient Satisfaction Scoring (PSS).
The mean age of the 19 patients who underwent LHM was 49.37±10.48 years. The mean age of the 17 patients who underwent EBD was 59.24±14.39 years. Perioperative complications included esophageal mucosal perforation in one patient in the LHM group, bleeding in three patients (17.64%), and esophageal perforation in one patient (5.88%) in the EBD group. At a mean follow-up of 90 months, gastroesophageal reflux developed in two patients (10.53%) in the LHM group and eight patients (47%) in the EBD group. The Pre-ES was similar in both groups. The Post-ES significantly decreased in the LHM group compared to the EBD group. When ASQL and PSS results were analyzed between the LHM and EBD groups, it was concluded that LHM was more effective than EBD in improving the quality of life and providing patient satisfaction (p-value: 0.001).
In light of these findings, it was concluded that LHM is a safer intervention compared to EBD and should be prioritized, considering the low risk of complications, improved quality of life, and high level of satisfaction.
贲门失弛缓症是一种罕见的食管神经退行性疾病，导致食管蠕动受损和食管下括约肌（LES）松弛障碍。这会导致吞咽困难、反流、胸痛和体重减轻等症状。在治疗选择中，腹腔镜 Heller 肌切开术（LHM）、内镜球囊扩张术（EBD）和经口内镜肌切开术（POEM）是常用的方法。本研究旨在比较 LHM 和 EBD 治疗贲门失弛缓症的疗效和临床长期结果。
回顾贝济米耶勒瓦库夫大学医院的患者记录，纳入 36 例接受 LHM 和 EBD 的贲门失弛缓症患者。患者使用术前 Eckardt 评分（Pre-ES）进行术前评估，术后 Eckardt 评分（Post-ES）进行术后评估，贲门失弛缓症特异性生活质量问卷（ASQL）和患者满意度评分（PSS）进行评估。
19 例行 LHM 的患者平均年龄为 49.37±10.48 岁，17 例行 EBD 的患者平均年龄为 59.24±14.39 岁。LHM 组有 1 例患者发生食管黏膜穿孔，EBD 组有 3 例（17.64%）患者发生出血，1 例（5.88%）患者发生食管穿孔。平均随访 90 个月后，LHM 组有 2 例（10.53%）患者发生胃食管反流，EBD 组有 8 例（47%）患者发生胃食管反流。两组患者的 Pre-ES 相似。与 EBD 组相比，LHM 组的 Post-ES 显著降低。当分析 LHM 和 EBD 组之间的 ASQL 和 PSS 结果时，得出结论，LHM 在改善生活质量和提供患者满意度方面比 EBD 更有效（p 值：0.001）。
鉴于这些发现，与 EBD 相比，LHM 是一种更安全的干预措施，应优先考虑，因为其并发症风险低、生活质量改善和满意度高。
