腔镜下食管肌层切开术治疗贲门失弛缓症76例分析  

Minimally invasive esophagectomy:outcomes in 76 patients

作　　者：王雪海[1] 甘崇志[1] 曾富春[1] 陈凡[1] 舒骏[1] 丛伟[1] 

机构地区：[1]四川省医学科学院.四川省人民医院心胸外科,四川成都610072

出　　处：《实用医院临床杂志》2010年第4期55-57,共3页Practical Journal of Clinical Medicine

摘　　要：目的探讨贲门失弛缓症腔镜下食管肌层切开术手术效果的相关因素。方法回顾性分析我院1999～2009年行腔镜下Heller手术治疗的76例贲门失弛缓症患者围术期死亡率、并发症发生率、症状改善程度、是否需要术后干预等,多变量分析用于鉴定影响手术效果的临床因素。结果共有76例贲门失弛缓症患者(男39例,女37例)接受了腹腔镜(n=46)或胸腔镜(n=30)下Heller手术,大部分进行了胃底折叠术。平均随访时间是29.6月,平均住院时间是6天,无手术死亡。有43例(56.5%)患者术前曾接受了内窥镜治疗(内窥镜下球囊扩张术或肉毒杆菌毒素注射治疗)。研究表明术前曾接受过内窥镜治疗的患者手术失败率远大于未曾接受过内窥镜治疗的患者(11.6%vs 3.0%,P=0.002)。多变量分析还显示长病程、S型的食管改变、术前食管下段括约肌低压力与手术效果呈负相关。结论术前曾接受过内窥镜治疗的患者手术失败率明显增加,其他与手术失败相关的因素包括长病程,S型的食管改变,术前食管下段括约肌低压力等。尽管内窥镜治疗是治疗贲门失迟缓症的一个重要方法,但腔镜下Heller手术应成为治疗贲门失弛缓症的首选方法。Objective To review our experience with minimally-invasive as primary therapy for achalasia,and to identify those clinical variables most predictive of myotomy failure.Methods We reviewed our experience with all patients who underwent minimally-invasive Heller myotomy from 1999 to 2009.Outcome variables analyzed included perioperative morbidity and mortality,symptomatic improvement,and requirement for postoperative interventions.Multivariate analysis was performed to identify clinical variables predictive of myotomy failure.Results A total of 76 consecutive patients(39 men and 37 women) underwent minimally-invasive laparoscopic(n = 46) or thoracoscopic(n = 30) Heller myotomy with partial fundoplication.Mean follow-up was 29.6 months.Median hospital stay was 6 days,with no operative mortality.There were 43 patients(56.5%) who had undergone prior endoscopic treatment(endoscopic dilation or botulinum toxin injection).An increased failure rate was noted in patients with prior endoscopic therapies(11.6% vs 3.0%,P = 0.002).Multivariate analysis also revealed that longer duration of symptoms,sigmoidal esophageal changes,and low preoperative lower esophageal sphincter pressures impact adversely on the success of myotomy.Conclusion There was an increase in treatment failures among patients undergoing preoperative endoscopic treatment.Other factors associated with failure during long-term follow-up include longer duration of symptoms,sigmoidal esophagus,and low baseline lower esophageal sphincter pressure.Although endoscopic modalities remain an important component of the armamentarium in the treatment of patients with achalasia,consideration should be given to minimally-invasive Heller myotomy as primary therapy for this condition.

关 键 词：微创 食管肌层切开术 贲门失弛缓症 

分 类 号：R4[医药卫生—临床医学]