机器人腹腔镜Heller肌切开联合Dor折叠术治疗贲门失弛缓症学习曲线与短期疗效的单中心回顾性研究  

Short-term outcomes and learning curve of the robot-assisted Heller-Dor myotomy for achalasia of cardia:A single-center retrospective study

作　　者：叶春林 魏光夏 徐凯英 蒋磊 胥彬 李泉金 胡智 喻本桐[1] 唐建[1] YE Chunlin;WEI Guangxia;XU Kaiying;JIANG Lei;XU Bin;LI Quanjin;HU Zhi;YU Bentong;TANG Jian(Department of Thoracic Surgery,The First Affiliated Hospital of Nanchang University,Nanchang,330006,P.R.China;Human Genetic Resources Center,The First Affiliated Hospital of Nanchang University,Nanchang,330006,P.R.China)

机构地区：[1]南昌大学第一附属医院胸外科,南昌330006 [2]南昌大学第一附属医院人类遗传资源中心库,南昌330006

出　　处：《中国胸心血管外科临床杂志》2022年第4期443-448,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：江西省科技厅重点研发计划一般项目(20192BBG70040);江西省卫生健康委基金(20203189)。

摘　　要：目的探讨机器人腹腔镜Heller肌切开联合Dor折叠术(robot-assisted Heller-Dor myotomy,RAHM-Dor)治疗贲门失弛缓症的短期疗效和学习曲线。方法回顾性分析南昌大学第一附属医院胸外科2015年11月—2020年1月42例行RAHM-Dor患者的临床资料及短期随访结果,其中男20例、女22例,平均年龄为(40.8±18.4)岁。结果吞咽困难为术前最常见的症状,其次为烧心和反流。全组患者均采用RAHM-Dor,平均手术时间(122.8±23.9)min,术中出血量(47.5±32.7)m L,其中2例患者出现术中食管黏膜穿孔,术中进行黏膜缝合修补。中位住院时间为8(6,9)d,无术后食管瘘、中转开腹及围术期死亡患者。所有患者1个月、6个月及12个月Stooler评分和Eckardt评分较术前降低(P<0.001)。结论RAHM-Dor应用于贲门失弛缓症安全可行,可获得较满意的短期疗效,初始16~18例手术后,学习曲线即可从学习阶段进入到标准阶段。Objective To investigate short-term outcomes of robot-assisted Heller-Dor myotomy(RAHM-Dor)for achalasia of cardia and our learning curve experience.Methods The clinical data and recent follow-up results of 42patients who received RAHM-Dor from November 2015 to January 2020 in the Department of Thoracic Surgery of the First Affiliated Hospital of Nanchang University were retrospectively analyzed,including 20 males and 22 females with a mean age of 40.8±18.4 years.Results Dysphagia was the most common symptom,followed by heartburn and regurgitation.The mean operation time was 122.8±23.9 min.The mean blood loss was 47.5±32.7 m L.Two patients suffered mucosal injury,and successfully repaired by suturing during surgery.There was no esophageal fistula,conversion to an open operation or perioperative death in this series.The median length of hospital stay was 8(6,9)d.In all patients,the Stooler and Eckardt scores of postoperative 1,6 and 12 months decreased compared to those of pre-operation(P<0.001).Conclusion RAHM-Dor is a safe and feasible avenue for the treatment of achalasia of cardia,and can achieve a satisfying short-term results.The learning curve shows a transition to the standard stage from the learning stage after 16-18 operations.

关 键 词：贲门失弛缓症 Heller肌切开术 胃底折叠术 机器人手术 

分 类 号：R656.61[医药卫生—外科学]