Ling 分型对经口内镜下肌切开术手术并发症的影响

Effects of Ling classification of achalasia on complications of peroral endoscopic myotomy

目的 探讨贲门失弛缓症Ling分型对经口内镜下肌切开术(POEM)手术并发症的影响.方法 分析前瞻性记录的2010年10月至2012年9月期间POEM治疗的47例贲门失弛缓症患者的资料,对比不同Ling分型的患者接受POEM治疗时手术并发症发生率.结果 47例患者接受POEM治疗,男25例,女22例,年龄16 ～ 62岁,平均39.0岁.Ling Ⅰ型24例,LingⅡa型5例,LingⅡb型14例,LingⅡc型4例.共14例出现并发症(29.8％),黏膜穿孔5例(10.6％),气体相关并发症10例(21.3％),其中1例同时合并黏膜穿孔和气体相关并发症.气体相关并发症包括气胸、纵隔积气、腹腔积气及皮下气肿.黏膜穿孔的发生率LingⅡb型最高,为21.4％；Ling Ⅰ型次之,为8.3％；LingⅡa型和LingⅡ.型均未发生并发症.气体相关并发症的发生率LingⅡc型最高,为50％；Ling Ⅰ型、LingⅡa和LingⅡb型分别为25％、20％和7.1％.结论 总的并发症发生率和气体相关并发症的发生率LingⅡc型最高,黏膜穿孔发生率LingⅡb型最高.

Objective To determine effects Ling classification of achalasia on complications of peroral endoscopic myotomy (POEM).Methods From October 2010 to September 2012,47 patients of achalasia underwent POEM and were prospectively registered in the database of our digestive center.And complication rates of different types of Ling classification were compared. Results Among the 47 patients,25 were male and 22 were female with a average age of 39.0 years ranging from 16 to 62.Twenty-four patients were of type Ling,and 5 of Ling Ⅱa,14 of Ling Ⅱb,4 of Ling Ⅱc and none of Ling Ⅲ.Fourteen out of the 47 patients (29.8 %) had complications including 5 mucosal perforations and 10 gas-related complications,and one patient had both mucosal perforation and gas-related complication. Gas-ralated complications included pneumothorax, pneumomediastinum,pneumoperitoneum and subcutaneous emphysema. Rate of mucosal perforation was highest in type Ling Ⅱb with 21.4 %,and was 8.3 % in Ling Ⅰ and 0 in Ling Ⅱa and Ling Ⅱc.Rate of gas-related complication was highest in Ling Ⅱc with 50 %,and was 25 %,20 % and 7.1 % respectively in Ling Ⅰ,Ling Ⅱa and Ling Ⅱb.Conclusions Total complication rate and gas-related complication rate were highest in patients of type Ling Ⅱc and mucosal perforation rate was highest in type LingⅡb.