目的比较腹腔镜Heller手术(laparoscopic heller myotomy,LHM)和经口内镜下肌切开术(peroral endoscopic myotomy,POEM)治疗贲门失弛缓症的临床疗效,探讨POEM术后胃食管反流并发症的治疗策略。方法采用回顾性队列研究的方法,收集2012年1...目的比较腹腔镜Heller手术(laparoscopic heller myotomy,LHM)和经口内镜下肌切开术(peroral endoscopic myotomy,POEM)治疗贲门失弛缓症的临床疗效,探讨POEM术后胃食管反流并发症的治疗策略。方法采用回顾性队列研究的方法,收集2012年10月至2017年4月我院收治的61例贲门失弛缓症患者的临床资料,其中30例行腹腔镜Heller手术加部分胃底折叠术(Dor)为腹腔镜组(LHM组);31例行经口内镜下肌切开术为内镜组(POEM组),随访至2019年4月,比较两组患者的基本资料、手术情况、临床疗效以及胃食管反流并发症(包括胃食管反流症状、病理性酸反流、食管炎)的情况。结果患者均顺利完成手术,无围术期死亡。LHM组和POEM组患者在手术时间、术中出血量、围术期并发症、平均住院日、住院费用等方面差异无统计学意义。LHM组和POEM组的治疗有效率分别为86.7%(26/30)和90.3%(28/31),差异无统计学意义。两组患者术后Ecardt评分、下段食管静息压较术前均明显下降(P<0.001),但两组之间比较,差异无统计学意义;POEM组术后胃食管反流症状(3/27 vs 11/20,P=0.018)、病理性酸反流(4/26 vs 12/18,P=0.024)、食管炎(2/28 vs 9/22,P=0.023)发生率显著高于LHM组。临床相关胃食管反流发生率在POEM组更高(1/29 vs 7/24,P=0.026)。结论 LHM与POEM治疗贲门失弛缓症的安全性及中远期疗效相近,但是POEM手术缺乏抗反流措施,可导致胃食管反流发生率升高,术后应密切随访并积极干预。展开更多
目的系统评价腹腔镜Heller肌切开术(LHM)与经口内镜下肌切开术(POEM)治疗贲门失弛缓症的疗效及安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science及万方数据库、维普数据库、中国知网数据库(CNKI),搜索建库...目的系统评价腹腔镜Heller肌切开术(LHM)与经口内镜下肌切开术(POEM)治疗贲门失弛缓症的疗效及安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science及万方数据库、维普数据库、中国知网数据库(CNKI),搜索建库至2023年11月公开发表的相关文献,采用RevMan 5.0软件进行meta分析。结果共纳入15篇文献,其中1篇是随机对照试验,8篇是回顾性队列研究,6篇是前瞻性非随机对照试验。共1439例患者,LHM组696例,POEM组743例。Meta分析结果显示,与LHM组相比,POEM组术后吞咽困难复发率更低[OR=2.01,95%CI(1.17,3.44),P=0.01]、手术时间更短[MD=22.66,95%CI(5.57,39.75),P=0.009]、住院时间更短[MD=0.55,95%CI(0.38,0.71),P<0.01]、术后恢复正常生活天数更少[MD=4.49,95%CI(4.00,4.97),P<0.01],在胃食管反流病发生率和术后皮下气肿发生率上LHM低于POEM[OR=0.64,95%CI(0.45,0.90),P=0.009;OR=0.33,95%CI(0.11,0.99),P=0.05];而在术后总并发症发生率、术后质子泵抑制剂使用率、术后6个月Eckardt评分等方面,两个术式差异无统计学意义(P>0.05)。结论与LHM相比,POEM术后吞咽困难复发率、手术时间、住院时间、术后恢复正常生活天数更具优势。展开更多
AIM:To compare the outcome of acid reflux prevention by Dor fundoplication after laparoscopic Heller myotomy(LHM)for achalasia.METHODS:Electronic database PubMed,Ovid(Evidence-Based Medicine Reviews,EmBase and Ovid ME...AIM:To compare the outcome of acid reflux prevention by Dor fundoplication after laparoscopic Heller myotomy(LHM)for achalasia.METHODS:Electronic database PubMed,Ovid(Evidence-Based Medicine Reviews,EmBase and Ovid MEDLINE)and Cochrane Library were searched between January 1995 and September 2012.Bibliographic citation management software(EndNote X3)was used for extracted literature management.Quality assessment of random controlled studies(RCTs)and non-RCTs was performed according to the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0and a modification of the Newcastle-Ottawa Scale,respectively.The data were analyzed using Review Manager(Version 5.1),and sensitivity analysis was performed by sequentially omitting each study.RESULTS:Finally,6 studies,including a total of 523achalasia patients,compared Dor fundoplication with other types of fundoplication after LHM(Dor-other group),and 8 studies,including a total of 528 achalasia patients,compared Dor fundoplication with no fundoplication after LHM(Dor-no group).Dor fundoplication was associated with a significantly higher recurrence rate of clinical regurgitation and pathological acid reflux compared with the other fundoplication group(OR=7.16,95%CI:1.25-40.93,P=0.03,and OR=3.79,95%CI:1.23-11.72,P=0.02,respectively).In addition,there were no significant differences between Dor fundoplication and no fundoplication in all subjects.Other outcomes,including complications,dysphagia,postoperative physiologic testing,and operation-related data displayed no significant differences in the two comparison groups.CONCLUSION:Dor fundoplication is not the optimum procedure after LHM for achalasia.We suggest more attention should be paid on quality of life among different fundoplications.展开更多
目的：探讨免气腹辅助3D腹腔镜改良 Heller 肌切开联合 Dor 胃底折叠治疗贲门失弛缓症的临床价值。方法2013年7月～2015年11月对32例贲门失弛缓症行免气腹辅助3D腹腔镜下贲门食管肌层切开，联合Dor胃底折叠术（前部180＆#176;胃底折叠...目的：探讨免气腹辅助3D腹腔镜改良 Heller 肌切开联合 Dor 胃底折叠治疗贲门失弛缓症的临床价值。方法2013年7月～2015年11月对32例贲门失弛缓症行免气腹辅助3D腹腔镜下贲门食管肌层切开，联合Dor胃底折叠术（前部180＆#176;胃底折叠缝合术）。结果32例均成功完成免气腹腹腔镜手术，手术时间（71．6±36．8） min，术中出血量（23．6±18．4）ml，住院时间（8．2±2．6）d，无食管漏等并发症及死亡。32例术后随访6～34个月，平均15．3月，Eckardt评分Ⅰ级20例（62．5％），Ⅱ级9例（28．1％），Ⅲ级3例（9．4％）；手术有效29例（90．6％），失败3例（9．4％）。23例术后6个月复查食管吞钡造影，食管最大横径（31．1±5．2）mm，较术前（45．3±8．0）mm明显改善（t＝11．064，P＝0．000）。结论免气腹辅助3D腹腔镜改良Heller联合Dor胃底折叠术治疗贲门失弛缓症疗效满意。展开更多
文摘目的比较腹腔镜Heller手术(laparoscopic heller myotomy,LHM)和经口内镜下肌切开术(peroral endoscopic myotomy,POEM)治疗贲门失弛缓症的临床疗效,探讨POEM术后胃食管反流并发症的治疗策略。方法采用回顾性队列研究的方法,收集2012年10月至2017年4月我院收治的61例贲门失弛缓症患者的临床资料,其中30例行腹腔镜Heller手术加部分胃底折叠术(Dor)为腹腔镜组(LHM组);31例行经口内镜下肌切开术为内镜组(POEM组),随访至2019年4月,比较两组患者的基本资料、手术情况、临床疗效以及胃食管反流并发症(包括胃食管反流症状、病理性酸反流、食管炎)的情况。结果患者均顺利完成手术,无围术期死亡。LHM组和POEM组患者在手术时间、术中出血量、围术期并发症、平均住院日、住院费用等方面差异无统计学意义。LHM组和POEM组的治疗有效率分别为86.7%(26/30)和90.3%(28/31),差异无统计学意义。两组患者术后Ecardt评分、下段食管静息压较术前均明显下降(P<0.001),但两组之间比较,差异无统计学意义;POEM组术后胃食管反流症状(3/27 vs 11/20,P=0.018)、病理性酸反流(4/26 vs 12/18,P=0.024)、食管炎(2/28 vs 9/22,P=0.023)发生率显著高于LHM组。临床相关胃食管反流发生率在POEM组更高(1/29 vs 7/24,P=0.026)。结论 LHM与POEM治疗贲门失弛缓症的安全性及中远期疗效相近,但是POEM手术缺乏抗反流措施,可导致胃食管反流发生率升高,术后应密切随访并积极干预。
基金Supported by National Natural Science Foundation of China,Grant 81172373
文摘AIM:To compare the outcome of acid reflux prevention by Dor fundoplication after laparoscopic Heller myotomy(LHM)for achalasia.METHODS:Electronic database PubMed,Ovid(Evidence-Based Medicine Reviews,EmBase and Ovid MEDLINE)and Cochrane Library were searched between January 1995 and September 2012.Bibliographic citation management software(EndNote X3)was used for extracted literature management.Quality assessment of random controlled studies(RCTs)and non-RCTs was performed according to the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0and a modification of the Newcastle-Ottawa Scale,respectively.The data were analyzed using Review Manager(Version 5.1),and sensitivity analysis was performed by sequentially omitting each study.RESULTS:Finally,6 studies,including a total of 523achalasia patients,compared Dor fundoplication with other types of fundoplication after LHM(Dor-other group),and 8 studies,including a total of 528 achalasia patients,compared Dor fundoplication with no fundoplication after LHM(Dor-no group).Dor fundoplication was associated with a significantly higher recurrence rate of clinical regurgitation and pathological acid reflux compared with the other fundoplication group(OR=7.16,95%CI:1.25-40.93,P=0.03,and OR=3.79,95%CI:1.23-11.72,P=0.02,respectively).In addition,there were no significant differences between Dor fundoplication and no fundoplication in all subjects.Other outcomes,including complications,dysphagia,postoperative physiologic testing,and operation-related data displayed no significant differences in the two comparison groups.CONCLUSION:Dor fundoplication is not the optimum procedure after LHM for achalasia.We suggest more attention should be paid on quality of life among different fundoplications.
文摘目的系统评价腹腔镜Heller术与气囊扩张比较治疗贲门失弛缓症的疗效和安全性。方法计算机检索Cochrane图书馆RCT数据库、Pub Med、EMbase、CBM、VIP、和Wan Fang等数据库建库至2016年12月。收集全世界腹腔镜Heller术与气囊扩张比较治疗贲门失弛缓症的RCT。采用Rev Man 5.2软件进行Meta分析。结果纳入4个RCT(437例)患者。Meta分析显示:(1)总体症状缓解率:LHM优于PD(78.38%和68.52%,P=0.04)。(2)手术相关穿孔发生率:LHM优于PD(0.50%和4.63%,P=0.02);(3)长期总体症状缓解率(24个月)、胃食管反流发生率、术后LES压力改善,两组差异无统计学意义。结论目前的证据表明,LHM和PD均有较好的长期疗效,但LHM在疗效和安全性上更有优势,建议根据医疗水平和患者具体情况选择使用。
