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Robotic Myotomy and Partial Fundoplication for Achalasia
Published on: August 11, 2023
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laparoscopic Heller myotomy with Toupet
Megan Blaustein1, Rachel Sillcox2,3, Andrew S Wright1
1Department of Surgery, University of Washington, Seattle, WA, USA.
Surgical endoscopy
|December 15, 2023
概括
胃食道逆流病 (GERD) 经过腹腔镜的Heller肌肉切除术后,Toupet fundoplication (LHM+T) 治疗阿喀拉西亚是不常见的. 客观测试和手动审查pH值研究对于准确的诊断至关重要,将GERD与食道清除差异化.
科学领域:
- 胃肠病学 胃肠病学
- 手术创新 在外科创新.
- 消化系统健康 消化系统健康
背景情况:
- laparoscopic Heller myotomy (LHM) 与Toupet fundoplication (LHM+T) 是一种主要的治疗方法,旨在减少胃食道反流病 (GERD).
- 口腔内镜肌切除术 (POEM) 是一种新兴的替代方案,但其术后GERD的发生率需要仔细评估.
- 了解LHM+T后的GERD发病率和特征对于比较治疗疗效至关重要.
研究的目的:
- 在阿喀拉西亚患者中描述LHM+T后的GERD的发生和性质.
- 评估客观pH值研究与患者报告的LHM+T后的GERD症状之间的相关性.
- 为了确定在治疗阿喀拉西亚的患者中诊断GERD的挑战.
主要方法:
- 对从2012年1月至2022年4月接受LHM+T的成年阿喀拉西亚患者的回顾性评估.
- 收集了6个月后的手术后pH值研究和患者症状问卷.
- 统计分析 (克鲁斯卡尔-瓦利斯,奇正方形) 探索症状和pH值发现的差异.
主要成果:
- 在170名患者中,51人接受了评估;22%的人有异常pH值的研究.
- 只有15.6%的患者报告了GERD症状,平均严重程度和频率较低.
- 异常pH的研究与GERD症状增加相关 (50%与12.8%相比),但需要手动审查才能将GERD与食道清除差异化.
结论:
- 在LHM+T后,GERD的发病率相对较低.
- 由于症状相关性不可靠,客观的术后pH测试是必不可少的.
- 手动审查pH值研究对于准确诊断GERD和区分它与受损的食道酸清除至关重要.
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