经口内镜下肌切开术治疗贲门失弛缓症:单纯纵形切口与改良纵形切口的临床比较

Peroral endoscopic myotomy for achalasia: A comparative study of simple longitudinal mucosal incision and modified incision

目的:比较单纯纵形切口法和改良纵形切口法经口内镜下肌切开术(peroral endoscopic myotomy,POEM)治疗贲门失弛缓症(achalasia,AC)的疗效和安全性.方法:回顾性分析中南大学湘雅二医院2013-01/2014-04共75例行P O E M术治疗的A C患者的临床资料.根据纵形切口的类型将患者分为两组,即单纯纵形切口组和改良纵形切口组,比较两组在症状评分、手术时间、食管测压结果、并发症、随访等指标的差异.结果:75例患者均成功完成POEM术,其中采用单纯纵形切口法者26例,改良纵形切口法者49例,两组间操作时间差异无统计学意义.改良纵形切口法组气体相关并发症发生率低于单纯纵形切口组(P<0.05),其他并发症两组间无统计学差异.术后平均随访8 mo,术后Eckardt评分、食管下括约肌压力(lower esophageal sphincter pressure,LESP)均较术前均明显下降(6.4 vs 0.5,31.3 mmHg vs 6.49mmHg,P<0.01),有效率分别为96.2%(25/26),98.0%(48/49),均无复发,Eckardt评分及LESP下降情况、有效率、复发率两组间差异均无统计学意义.结论:单纯纵形切口法与改良纵形切口法POEM术治疗AC的短期疗效无显著差异,但改良纵形切口法可减少气体相关并发症发生率.

AIM： To compare the safety and efficacy of sim- ple longitudinal mucosal incision with modified incision during peroral endoscopic myotomy （POEM） for achalasia （AC）. METHODS： A total of 75 patients with AC were treated by POEM between January 2013and April 2014 at our hospital. According to the method of mucosal incision, patients were assigned to two groups, namely, a modified incision group and a simple longitudinal muco- sal incision group. Symptom relief, procedure- related parameters, manometry outcome, com- plications and follow-up data were collected and compared between the two groups.RESULTS： POEM was successful in all the 75 patients, of whom 26 received a simple lon- gitudinal mucosal incision and 49 received a modified incision. Eckardt score and lower esophageal sphincter pressure （LESP） decreased significantly during a median follow-up of eight months （preoperative vs postoperative： 6.4 vs 0.5, 31.3 mmHg vs 6.49 mmHg, P 〈 0.01）. Treat- ment success was achieved in 96.2% （25/26） of patients in the simple longitudinal mucosal incision group and in 98.0% （48/49） of patients in the modified incision group. No recurrence was noted. There was no significant difference in mean operative time, pre and post-treatment Eckardt＇s score, lower esophageal sphincter pressure, esophageal diameter, or recurrence rate between the two groups. However, patients in the modified incision group were less likely to develop gas-related complications （P 〈 0.05）.CONCLUSION： Short-term efficacy is compa- rable between the two groups, and modified incision can reduce the rate of gas-related com- plications.