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首页> 外文期刊>Surgical Endoscopy >Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia.
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Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia.

机译：长期结果证实，扩展的Heller肌切开术与Toupet胃底折叠术对于门失弛缓症的疗效更高。

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BACKGROUND: The standard Heller myotomy (SM) for achalasia extends 1 to 2 cm on to the stomach. The authors perform an extended myotomy (EM) (>3 cm) with the goal of reducing postoperative dysphagia. This study examines the long-term efficacy and durability of EM compared with SM. METHODS: Patients with achalasia who underwent a laparoscopic Heller myotomy were identified from a prospective database that includes symptom evaluation and results of esophageal functional studies. From September 1994 to August 1998, the authors performed SM with Dor fundoplication, and from September 1998 through 2003, they performed EM with Toupet fundoplication. In 2001, they performed a telephone survey of all available patients. This was repeated in 2005 for the EM group. The survey included scales of symptom frequency (0 [never], 1 [once per month], 2 [once per week], 3 [once per day], 4 [more than once per day]) and severity (0 [no symptoms] to 10 [symptoms equal to preoperative state]) as well as the need to undergopostoperative intervention for dysphagia. RESULTS: For this study, 52 patients underwent SM with Dor fundoplication (median follow-up period, 46 +/- 24 months), and 63 patients underwent EM with Toupet fundoplication (median follow-up period, 45 +/- 17 months. Postoperative dysphagia severity was significantly better in the EM group (4.8 +/- 2.3 vs 3.1 +/- 2.6; p < 0.005). There was no significant difference in postoperative heartburn frequency, esophageal acid exposure, or lower esophageal sphincter pressure. In the SM group, 9 patients (17%) required reintervention for dysphagia: 14 endoscopic interventions for 5 patients (10%) and reoperation for 4 patients. Three patients (5%) in the EM group required reintervention for dysphagia: one endoscopic intervention each and no reoperations (p < 0.05). A total of 30 patients in the EM group were contacted in both 2001 (median follow-up period, 19 +/- 11 months) and 2005 (median follow-up period, 63 +/- 10 months). There was no significant change over time in dysphagia severity (2.6 +/- 1.9 vs 3.7 +/- 2.0; p = 0.19). CONCLUSIONS: For the treatment of achalasia, EM with Toupet fundoplication provides excellent durable dysphagia relief that is superior to SM with Dor fundoplication.
机译：背景：用于门失弛缓症的标准Heller肌切开术（SM）延伸至胃1到2 cm。作者进行了扩展肌切开术（EM）（> 3 cm），目的是减少术后吞咽困难。这项研究检验了与SM相比EM的长期疗效和耐久性。方法：从前瞻性数据库中识别出接受腹腔镜海勒肌切开术的门失弛缓患者，该数据库包括症状评估和食管功能研究的结果。从1994年9月至1998年8月，作者通过多发性胃底折叠术进行SM，从1998年9月至2003年，他们进行了Toupet胃底折叠术的EM。在2001年，他们对所有现有患者进行了电话调查。新兴市场集团在2005年重复了这一过程。调查包括症状频率（0 [从不]，1 [每月一次]，2 [每周一次]，3 [每天一次]，4 [每天不止一次]）和严重程度（0 [无症状] ]至10 [症状等于术前状态]），以及需要进行吞咽困难的术后干预。结果：对于本研究，有52例接受了Dor胃底折叠术的SM患者（中位随访期为46 +/- 24个月），以及63例接受了Toupet胃底折叠术的EM患者（中位随访期为45 +/- 17个月）。 EM组术后吞咽困难的严重程度明显好于对照组（4.8 +/- 2.3 vs 3.1 +/- 2.6; p <0.005），术后胃灼热频率，食管酸暴露或较低的食管括约肌压力无明显差异。 SM组9例（17％）需要进行吞咽困难的再次介入治疗：14例内镜下干预治疗5例患者（10％），再次手术4例; EM组中的3例患者（5％）需要进行吞咽困难的再次干预：每次内镜干预一次，无再次手术（p <0.05）。EM组在2001年（中位随访期，19 +/- 11个月）和2005年（中位随访期，63 +/- 10个月）总共接触了30例患者吞咽困难的严重程度并没有随时间的显着变化（2。 6 +/- 1.9和3.7 +/- 2.0 p = 0.19）。结论：对于up门失弛缓症的治疗，EM结合Toupet胃底折叠术可提供出色的持久吞咽困难缓解，优于Dor胃底折叠术的SM。

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