Wang Jing-Tao, Sun Yu-Xiang, Li Rui-Xin, Zhang Yun-Fei, Ding Heng-Xuan, Wang Guo-Jun, Gao Bu-Lang
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052, China.
Sci Rep. 2025 Jan 9;15(1):1470. doi: 10.1038/s41598-024-74143-8.
To investigate the safety and short-term effectiveness of laparoscopic-assisted cardiectomy with side-overlap esophagogastric reconstruction for the treatment of terminal or end-stage achalasia, patients with end-stage achalasia treated with laparoscopic-assisted cardiectomy with side-overlap esophagogastric reconstruction were retrospectively enrolled. The clinical data, surgical data and follow-up were analyzed. Among twenty-five patients enrolled, the achalasia type St was present in 12 (48%) patients, type Sg in 9 (36%), and type aSg in 4 (16%). The surgical time ranged 60-180 min (median 100 min) with an intraoperative blood loss 20-200 ml (median 50 ml). Five (20%) patients experienced complications within a week after surgery, with fever (> 38.5 ℃) in two (40%) patients within 3 days after surgery, abdominal incision infection in one (20%), and anastomotic leak in two (40%). The postoperative hospitalization time ranged 8-44 (median 10) days. Follow-up was conducted 6-38 months (median 16) after surgery. Compared with the preoperative Eckardt score (7.64 ± 1.32), the Eckardt score was significantly (P < 0.01) decreased at one month (0.52 ± 0.87), 6 (0.84 ± 1.11) and 12 (1.23 ± 1.23) months after surgery in all patients. The Eckardt score in type St was significantly (P < 0.05) smaller than in type Sg or aSg at 6 and 12 months after surgery. Seven patients maintained an Eckardt score 0 with complete relief of their symptoms. The effective rate was 100% for type St, 88.8% for type Sg, and 75% for type aSg. The effective rates at 1 month, 6 and 12 months after surgery were 100% (95% CI: 100% -100%), 96% (95% CI: 87.7 -100%), and 92% (95% CI: 80.6 -100%). Two patients were diagnosed with gastroesophageal reflux disease (GERD) at the end of the follow-up. The cumulative incidence of GERD at 1 month, 6 and 12 months after surgery was 0, 4% (95% confidence interval or CI: 0-12.3%), and 8% (95% CI: 0-19.4%). In conclusion, the laparoscopic-assisted cardiectomy with side-overlap esophagogastric reconstruction is safe and effective for the treatment of end-stage achalasia, and the effect is significantly better for achalasia type St than for types Sg and aSg.
为探讨腹腔镜辅助贲门切除术联合侧侧吻合食管胃重建术治疗终末期或晚期贲门失弛缓症的安全性及短期疗效，对接受腹腔镜辅助贲门切除术联合侧侧吻合食管胃重建术治疗的晚期贲门失弛缓症患者进行回顾性研究。分析其临床资料、手术数据及随访情况。纳入的25例患者中，12例（48%）为失弛缓症St型，9例（36%）为Sg型，4例（16%）为aSg型。手术时间为60 - 180分钟（中位时间100分钟），术中出血量为20 - 200毫升（中位出血量50毫升）。5例（20%）患者术后1周内出现并发症，其中2例（40%）患者术后3天内发热（> 38.5℃），1例（20%）出现腹部切口感染，2例（40%）出现吻合口漏。术后住院时间为8 - 44天（中位时间10天）。术后6 - 38个月（中位时间16个月）进行随访。与术前埃卡特评分（7.64±1.32）相比，所有患者术后1个月（0.52±0.87）、6个月（0.84±1.11）和12个月（1.23±1.23）时埃卡特评分均显著降低（P < 0.01）。术后6个月和12个月时，St型患者的埃卡特评分显著低于Sg型或aSg型患者（P < 0.05）。7例患者埃卡特评分为0，症状完全缓解。St型患者有效率为100%，Sg型为88.8%，aSg型为75%。术后1个月、6个月和12个月的有效率分别为100%（95%置信区间：100% - 100%）、96%（95%置信区间：87.7 - 100%）和92%（95%置信区间：80.6 - 100%）。随访结束时，2例患者被诊断为胃食管反流病（GERD）。术后1个月、6个月和12个月GERD的累积发病率分别为0、4%（95%置信区间：0 - 12.3%）和8%（95%置信区间：0 - 19.4%）。综上所述，腹腔镜辅助贲门切除术联合侧侧吻合食管胃重建术治疗晚期贲门失弛缓症安全有效，且对St型贲门失弛缓症的疗效明显优于Sg型和aSg型。
