Effect of laparoscopic esophagomyotomy on chest pain associated with achalasia and prediction of therapeutic outcomes
Effect of laparoscopic esophagomyotomy on chest pain associated with achalasia and prediction of therapeutic outcomes
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DOI：
10.1007/s00464-010-1314-5
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发表时间：
2011-04-01
影响因子：
3.1
通讯作者：
Yanaga, Katsuhiko
中科院分区：
文献类型：
--
作者：
Omura, Nobuo;Kashiwagi, Hideyuki;Yanaga, Katsuhiko
贲门失弛缓症的肌切开术对胸痛的影响尚未明确。本研究旨在探讨腹腔镜肌切开术对贲门失弛缓症相关胸痛的治疗效果，并确定预后因素的outcomes.Between 2005年3月和2008年9月，95例患者进行了详细的访谈和评估清除定时钡食管造影（TBE）手术前后。在95例患者中，研究了47例（24例男性;平均年龄42.9 ± 13.5岁）术前发生胸痛的患者。在术前和术后6个月详细询问受试者吞咽困难和胸痛情况。症状的频率和严重程度按0 - 4级评分。此外，将两种症状的频率等级乘以严重程度等级获得的值分别定义为吞咽困难评分和胸痛评分。术后胸痛评分为0分者为A组，小于术前评分者为B组。其余有其他评分的患者定义为C组。比较三组患者的背景因素和临床情况，平均胸痛评分从5.0 ± A3.2下降到1.0 ± A1.6（p < 0.001）。27例患者术后评分为0，15例患者评分下降。虽然三组的特征没有差异，但术后TBE因素存在差异（即，A、B组术后1、5 min钡柱明显短于C组（p = 0.001）。腹腔镜肌切开术对贲门失弛缓症相关胸痛有治疗作用，术后食管清除率的提高可能影响治疗效果。
The effect of myotomy for achalasia on chest pain has not been clarified. The current study aimed to investigate the therapeutic effect of laparoscopic myotomy on chest pain associated with achalasia and to identify prognostic factors for outcomes.Between March 2005 and September 2008, 95 patients were available for detailed interviews and for assessment of clearance by timed barium esophagogram (TBE) before and after surgery. Of the 95 patients, 47 (24 men; mean age, 42.9 +/- A 13.5 years) who experienced chest pain before surgery were studied. The subjects were asked in detail about dysphagia and chest pain before surgery and 6 months after surgery. The frequency and severity of the symptoms were graded on a scale of 0 to 4. In addition, the values obtained by multiplying the grade for frequency by the grades for severity of the two symptoms were defined as the dysphagia score and the chest pain score, respectively. The patients with chest pain scores of 0 after surgery were defined as group A and those with scores smaller than their preoperative scores as group B. The remaining patients with other scores were defined as group C. The background factors and clinical conditions of the three groups were compared.The mean chest pain score decreased from 5.0 +/- A 3.2 to 1.0 +/- A 1.6 (p < 0.001). The score after surgery was 0 for 27 patients and showed a decrease for 15 patients. Although the three groups did not differ in their characteristics, differences were noted in postoperative TBE factors (i.e., groups A and B had significantly shorter barium columns than group C at 1 and 5 min after surgery (p = 0.001).Laparoscopic myotomy had a therapeutic effect on chest pain associated with achalasia, and improvement in postoperative esophageal clearance may influence the therapeutic effect.