渐近全层肌切开式经口内镜下肌切开术治疗贲门失弛缓症41例临床疗效分析

Clinical curative effect of asymptotic full-thickness myotomy type of peroral endoscopic myotomy on 41 cases of achalasia

目的通过总结渐近全层肌切开式经口内镜下肌切开术（POEM）治疗贲门失弛缓症的疗效，促进POEM的发展。方法从2010年12月至2014年1月间行POEM术的188例患者中，选择行渐进式POEM的患者41例，对术后症状缓解及反流情况进行自身对照比较及分析。结果41例患者术后症状Eckardt评分较术前有明显改善（P〈0．001），食管动力测压结果也证实了症状缓解的成效。术后反流发生率在症状学和胃镜下表现分别为26．83％和27．27％。结论渐进全层肌切开式POEM可有效缓解贲门失弛缓症的症状，其防反流的成果也初步令人满意。

Objective To evaluate the curative effect of asymptotic full-thickness myotomy type of peroral endoscopic myotomy（POEM） for achalasia. Methods Data of 41 patients who underwent asymptotic POEM at our digestive endoscopy center from December 10~ 2010 to January 10~ 2014 were retrospectively studied. The postoperative and preoperative symptoms and reflux were compared. Results The postoperative Eckardt scores of symptoms of 41 patients improved significantly（P 〈0. 001 ） compared with before. Esophageal dynamic pressure also showed the effectiveness of symptom relief. The incidence of postoperative reflux in symptoms and gastroscopy were 26. 83% and 27.27%, respectively. Conclusion Asymptotic fullthickness myotomy POEM can alleviate the symptoms of achalasia and the effect of inhibiting reflux is gener- ally satisfactory.