背景:晚期大食道易发生营养不良感染和癌症,除了对生活质量有重大影响。目前文献中对于晚期大食道的最佳手术选择尚无共识,尽管食管切除术有好的选择,尽管这种手术与显著的发病率和死亡率相关。其他外科手术,比如食管粘膜切除术和Heller心肌切开术,已经提出了很好的效果。
目的:对晚期巨食管外科治疗文献进行系统评价和荟萃分析。
方法:使用的数据库包括PubMed,拉丁美洲和加勒比健康科学文献(丁香花),Embase和医学文献分析和检索系统在线(MedLine),以及参考研究。两名审阅者独立选择了文章。
结果:共选取14篇文章,其中包括1,862名患者。研究分为两组:腹腔镜下胃底折叠术(213例)和大型手术(1,649例)。关于两组的晚期结局,研究大多取得了良好或优异的结果。然而,与大型手术组相关的发病率显著。
结论:腹腔镜Heller肌切开术可用于晚期巨食管患者,与大型手术相比,并发症和死亡率较低,对后期结果持保留意见。
BACKGROUND: Advanced megaesophagus predisposes to risks of malnutrition infections and cancer, in addition to having a significant impact on quality of life. There is currently no consensus in the literature regarding the best surgical option for advanced megaesophagus, although there is a predilection for esophagectomy, despite this surgery being associated with significant morbidity and mortality. Other surgical procedures, such as esophageal mucosectomy and Heller cardiomyotomy, have been proposed with good results.
OBJECTIVE: To conduct a systematic review and meta-analysis of the literature on the surgical treatment of advanced megaesophagus.
METHODS: Databases used included PubMed, Latin American and Caribbean Health Sciences Literature (Lilacs), Embase and Medical Literature Analysis and Retrieval System Online (MedLine), as well as reference research. Two reviewers selected the articles independently.
RESULTS: A total of 14 articles were chosen, which included 1,862 patients. The studies were divided into two groups: laparoscopic cardiomyotomy with fundoplication (213 patients) and major surgeries (1,649 patients). The studies yielded mostly good or excellent results regarding late outcomes in both groups. However, there was significant morbidity associated with the major surgeries group.
CONCLUSIONS: Laparoscopic Heller myotomy can be performed on patients with advanced megaesophagus, with lower rates of complications and mortality compared to major surgeries, with reservations regarding late outcomes results.