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@#Objective To investigate short-term outcomes of robot-assisted Heller-Dor myotomy (RAHM-Dor) for achalasia of cardia and our learning curve experience. Methods The clinical data and recent follow-up results of 42 patients who received RAHM-Dor from November 2015 to January 2020 in the Department of Thoracic Surgery of the First Affiliated Hospital of Nanchang University were retrospectively analyzed, including 20 males and 22 females with a mean age of 40.8±18.4 years. Results Dysphagia was the most common symptom, followed by heartburn and regurgitation. The mean operation time was 122.8±23.9 min. The mean blood loss was 47.5±32.7 mL. Two patients suffered mucosal injury, and successfully repaired by suturing during surgery. There was no esophageal fistula, conversion to an open operation or perioperative death in this series. The median length of hospital stay was 8 (6, 9) d. In all patients, the Stooler and Eckardt scores of postoperative 1, 6 and 12 months decreased compared to those of pre-operation (P<0.001). Conclusion RAHM-Dor is a safe and feasible avenue for the treatment of achalasia of cardia, and can achieve a satisfying short-term results. The learning curve shows a transition to the standard stage from the learning stage after 16-18 operations.
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Objective Under the method of a Meta-analysis, evaluate the early and long-term curative effect after coronary artery bypass grafting with the comparison of benefit and safety between dual anti-platelet therapy and aspirin therapy alone.Methods Medline, Embase, ScienceDirect and Cochrane Library were searched to identify randomized controlled trials concerning the comparison of benefit and safety between dual anti-platelet therapy and aspirin therapy alone, with extraction effect sizes including mortality, bleeding events, myocardial ischemia and graft occlusion.Newcastle-Ottawa Scale and Jadal scales were used to evaluate the quality of observational case-control studies and randomized controlled studies.Statistical analysis was performed using Meta R.15.2 software package.Results 15 literatures were enrolled for Meta-analyses, including 8randomized controlled studies, 3 prospective observational studies and 4 retrospective observational studies.Among a total of 31 365patiens, 8 642 patients were received combination therapy of aspirin and clopidogrel after CABG, and 22 723 patients were received combination therapy of aspirin and placebo or aspirin therapy alone.The Meta-analysis results, with comparison of the early postoperative curative effect in 13 literatures, showed that, relative to aspirin therapy alone, dual anti-platelet therapy could reduce the risk of graft occlusion(OR =0.53,95％ CI: 0.37-0.76, P =0.001), reduce the risk of myocardial ischemia (OR =0.84, 95 ％ CI: 0.71-0.99, P =0.038) , reduce the risk of mortality after CABG (OR =0.47,95 ％ CI: 0.36-0.61, P ＜0.001), simultaneously not increase the risk of bleeding events.The Meta-analysis results, with comparison of the long-term postoperative curative effect in 2 literatures, showed that the significant difference could not be found between two method of therapy about affecting the risk of graft occlusion (OR =0.40, 95 ％ CI: 0.02-6.90, P =0.523) , myocardial ischemia(OR =0.49, 95％ CI: 0.04-6.10, P =0.597), and mortality (OR =0.55, 95 ％ CI: 0.13-2.80, P =0.420).Conclusion Relative to aspirin therapy alone, dual anti-platelet therapy has better efficacy and safety in early postoperative term.However better long-term curative effect of dual anti-platelet therapy are not be confirmed, and more long-term follow-up studies are necessary to provide evidence based medicine.