КАЧЕСТВО ЖИЗНИ ПАЦИЕНТОВ С АХАЛАЗИЕЙ КАРДИИ В ОТДАЛЕННОМ ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ ПРИ 2–4 СТАДИЯХ ЗАБОЛЕВАНИЯ

Abstract

Evaluation of life quality in patients with achalasia cardia (AC) during the postoperative period, regardless of the method of surgical treatment, remains an urgent topic. The purpose of the study was to assess the quality of life of patients with AC in the long-term postoperative period, depending on the stage of the disease at the time of surgery, by analyzing the results of patient questionnaires and data from instrumental methods for studying the function of the esophagus. Results. The data of 95 patients were analyzed, of which 32 people were with stage 2, 33 people with stage 3 and 30 patients with stage 4 of the disease. All patients underwent the same type of surgical intervention, video endoscopic myotomy according to Heller with fundoplication according to Dor. The long-term period of postoperative follow-up ranged from 2 to 5 years. The results of traditional esophageal manometry and esophageal fluoroscopy were evaluated and the data from the Eckardt symptom score and GIGLI scale questionnaires were evaluated. The anthropometric data showed a statistically significant decrease in the tone of the lower esophageal sphincter in patients in all study groups to normal values (p =0.001). Data obtained during contrast X-ray examination of the esophagus and stomach after surgery revealed the restoration of the evacuation function of the esophagus in all patients (p=0.001). Motor function of the esophagus could not be restored in 6 patients with stage 4 AC, according to manometric data, atony of the esophagus was observed in these patients. The severity and frequency of dysphagia after surgical treatment, according to questionnaires, decreased significantly in patients with all stages of AC, in the long-term postoperative period, patients with stage 2 showed a decrease in the number of points scored by 68.9%, patients with stage 3 by 70.5% and patients with stage 4 of AC by 66.7% (p<0.05). Conclusions. According to Eckardt score and GIGLI questionnaires and instrumental methods of examination of esophageal function, video endoscopic esophagocardiomyotomy according to Heller with Dor fundoplication leads to a decrease in the main symptoms of achalasia of the cardia in patients with stages 2-4 of the disease and increases quality of life, while the best indicators were obtained in patients with stage 2 of the disease, which allows us to consider that it is advisable to perform this organ preservation operation already at the second stage of AC.