经口内镜下肌切开术对贲门失弛缓症患者的食管动力学影响

Effects of peroral endoscopic myotomy on esophageal dynamics in patients with esophagealachalasia

目的评价经口内镜下肌切开术（POEM）对贲门失弛缓症患者的食管动力学影响。方法2011年9．11月间复旦大学附属中山医院内镜中心对20例贲门失弛缓症患者行POEM手术．所有患者于术前和术后第3天利用固态高分辨率胃肠动力学检查系统行食管动力学检查．分析手术前后食管下括约肌静息压（LESP）、食管下括约肌4s完全松弛压（4sIRP）、食管下括约肌松弛率（LESRR）、食管下括约肌长度（LESL）和食管体部收缩性和传导性的变化。结果POEM术后，LESP由术前的（29．1±17．0）mmHg下降为（14．6±4．9）mmHg，下降幅度为49．8％（P〈0．01）；4slRP由术前的（24．2±15．1）mmHg下降为（10．4±3．4）mmHg（P〈0．01）；但手术前后LESRR和LESL的差异无统计学意义（P〉0．05）。20例患者术前食管运动均缺少蠕动性收缩，术后有7例患者食管收缩运动发生了变化，甚至出现了蠕动，但仍达不到正常水平；其余13例患者的蠕动情况无明显变化。结论POEM术可显著降低贲门失弛缓症患者食管下括约肌压力和松弛压．但对食管的收缩运动却无明显影响。

Objective To investigate the effects of peroral endoscopic myotomy （POEM） on esophageal dynamics in patients with esophageal achalasia. Methods From September 2011 to November 2011, 20 cases with esophageal achalasia received POEM at the Endoscopic Center in the Zhongshan Hospital of Fudan University. Pre-operation esophageal dynamics of all the patients were evaluated by high resolution manometry （HRM） system and 3 days after operation the test was repeated. Lower esophagus sphincter resting pressure （LESP）, 4-second integrated relaxation pressure （4sIRP）, lower esophagus sphincter relax rate （LESRR）, lower esophagus sphincter length （LESL）, and esophageal manometry were analyzed. Results After POEM, LESP decreased from（29.1±17.0） mm Hg to （14.6±4.9） mm Hg, and decrease rate was 49.8%（P〈0.01 ）. However, the decreases in LESRR and LESL were not statistically significant （P〉0.05）. Esophageal peristaltic contraction was absent in all the 20 patients preoperatively. After POEM, changes in the esophageal contraction were seen in 7 patients, and peristalsis was noticed but was below normal level. There were no significant changes in peristalsis in the remaining 13 patients. Conclusion POEM can significantly reduce LESP and 4sIRP in patients with achalasia, but can not affect the contraction of the esophagus.