Abstract：
BACKGROUND AND OBJECTIVES: Achalasia has several treatment modalities. We aim to compare the efficacy and safety of laparoscopic Heller myotomy (LHM) with those of pneumatic dilatation (PD) in adult patients suffering from achalasia.
METHODS: We searched Cochrane CENTRAL, PubMed, Web of Science, SCOPUS and Embase for related clinical trials about patients suffering from achalasia. The quality appraisal and assessment of risk of bias were conducted with GRADE and Cochrane\'s risk of bias tool, respectively. Homogeneous and heterogeneous data was analyzed under fixed and random-effects models, respectively.
RESULTS: The pooled analysis of 10 studies showed that PD was associated with a higher rate of remission at three months, one year, three years and five years (RR = 1.25 [1.09, 1.42] (p = 0.001); RR = 1.13 [1.05, 1.20] (p = 0.0004); RR = 1.48 [1.19, 1.82] (p = 0.0003); RR = 1.49 [1.18, 1.89] (p = 0.001)), respectively. LHM was associated with lower number of cases suffering from adverse events, dysphagia and relapses (RR = 0.50 [0.25, 0.98] (p = 0.04); RR = 0.33 [0.16, 0.71] (p = 0.004); RR = 0.38 [0.15, 0.97] (p = 0.04)), respectively. There is no significant difference between both groups regarding the lower esophageal pressure, perforations, remission rate at two years, Eckardt score after one year and reflux.
CONCLUSIONS: PD had higher remission rates than LHM at three months, one year and three years, but not at two years or five years. More research is needed to determine whether PD has a significant advantage over LHM in terms of long-term remission rates.
METHODS: We searched Cochrane CENTRAL, PubMed, Web of Science, SCOPUS and Embase for related clinical trials about patients suffering from achalasia. The quality appraisal and assessment of risk of bias were conducted with GRADE and Cochrane\'s risk of bias tool, respectively. Homogeneous and heterogeneous data was analyzed under fixed and random-effects models, respectively.
RESULTS: The pooled analysis of 10 studies showed that PD was associated with a higher rate of remission at three months, one year, three years and five years (RR = 1.25 [1.09, 1.42] (p = 0.001); RR = 1.13 [1.05, 1.20] (p = 0.0004); RR = 1.48 [1.19, 1.82] (p = 0.0003); RR = 1.49 [1.18, 1.89] (p = 0.001)), respectively. LHM was associated with lower number of cases suffering from adverse events, dysphagia and relapses (RR = 0.50 [0.25, 0.98] (p = 0.04); RR = 0.33 [0.16, 0.71] (p = 0.004); RR = 0.38 [0.15, 0.97] (p = 0.04)), respectively. There is no significant difference between both groups regarding the lower esophageal pressure, perforations, remission rate at two years, Eckardt score after one year and reflux.
CONCLUSIONS: PD had higher remission rates than LHM at three months, one year and three years, but not at two years or five years. More research is needed to determine whether PD has a significant advantage over LHM in terms of long-term remission rates.
摘要：
背景和目的：失语症有几种治疗方式。我们的目的是比较腹腔镜Heller肌切开术（LHM）与气压扩张术（PD）对患有门失弛缓症的成年患者的疗效和安全性。
方法：我们搜索了CochraneCENTRAL，PubMed,WebofScience,SCOPUS和Embase用于有关贲门失弛缓症患者的相关临床试验。利用GRADE和Cochrane的偏差风险工具对偏差风险进行质量评价和评估,分别。在固定和随机效应模型下分析了同质和异质数据，分别。
结果：对10项研究的汇总分析显示，PD在3个月时与较高的缓解率相关，一年,三年和五年（RR=1.25[1.09，1.42]（p=0.001）；RR=1.13[1.05，1.20]（p=0.0004）；RR=1.48[1.19，1.82]（p=0.0003）；RR=1.49[1.18，1.89]（p=0.001）），分别。LHM与较低的不良事件病例数相关，吞咽困难和复发（RR=0.50[0.25，0.98]（p=0.04）;RR=0.33[0.16，0.71]（p=0.004）;RR=0.38[0.15，0.97]（p=0.04）），分别。两组食管下压无显著差异,穿孔,两年的缓解率，一年后的Eckardt评分和反流。
结论：3个月时，PD的缓解率高于LHM，一年又三年,但不是两年或五年。需要更多的研究来确定PD在长期缓解率方面是否比LHM具有显著优势。
方法：我们搜索了CochraneCENTRAL，PubMed,WebofScience,SCOPUS和Embase用于有关贲门失弛缓症患者的相关临床试验。利用GRADE和Cochrane的偏差风险工具对偏差风险进行质量评价和评估,分别。在固定和随机效应模型下分析了同质和异质数据，分别。
结果：对10项研究的汇总分析显示，PD在3个月时与较高的缓解率相关，一年,三年和五年（RR=1.25[1.09，1.42]（p=0.001）；RR=1.13[1.05，1.20]（p=0.0004）；RR=1.48[1.19，1.82]（p=0.0003）；RR=1.49[1.18，1.89]（p=0.001）），分别。LHM与较低的不良事件病例数相关，吞咽困难和复发（RR=0.50[0.25，0.98]（p=0.04）;RR=0.33[0.16，0.71]（p=0.004）;RR=0.38[0.15，0.97]（p=0.04）），分别。两组食管下压无显著差异,穿孔,两年的缓解率，一年后的Eckardt评分和反流。
结论：3个月时，PD的缓解率高于LHM，一年又三年,但不是两年或五年。需要更多的研究来确定PD在长期缓解率方面是否比LHM具有显著优势。
