肺部扩张和手术肌肉切除用于阿喀拉西亚
Steven R Lopushinsky1, David R Urbach
1Department of Surgery, University of Toronto, Toronto, Ontario.
JAMA
|November 9, 2006
概括
与外科骨髓切割相比,用于治疗阿喀拉西亚的肺部扩张导致后续干预的风险更高. 这种差异主要是由于重复的气动扩张,而不是更多的手术.
科学领域:
- 胃肠病学 胃肠病学
- 手术创新 在外科创新.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 秋症的治疗通常涉及气动扩张或手术骨髓切割.
- 基于人群的结局数据比较这些阿喀拉西亚治疗方法是有限的.
研究的目的:
- 为了比较肺部扩张与手术肌肉切割作为阿喀拉西亚初始治疗的长期结果.
- 评估在初始阿喀拉西亚治疗后后续干预和医疗保健利用的需要.
主要方法:
- 在安大略省 (1991-2002年) 对1461名阿喀拉西亚患者 (≥18岁) 的回顾性研究.
- 对比初始气动扩张 (80.8%) 与手术肌肉切除 (19.2%).
- 分析了随后的干预,医生访问和药物使用,并对混因素进行调整.
主要成果:
- 在1,5年和10年后,对于气动扩张 (36.8%,56.2%,63.5%) 和手术肌肉切除 (16.4%,30.3%,37.5%) 的任何后续干预的累积风险更高.
- 随后干预的调整后危险比为2.37 (95% CI,1.86-3.02) 对于气动扩张.
- 随后的手术肌肉切除,食道切除,医生访问或胃肠道药物使用在两组之间没有显著差异.
结论:
- 在最初的阿喀拉西亚治疗后,后续干预是常见的.
- 肺部扩张与后续干预的风险比手术肌肉切割更大.
- 气动扩张带来的风险增加主要是由重复扩张手术引起的.
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