经口内镜肌切开术治疗贲门失弛缓症的临床疗效及生存质量评价

Short-term outcomes and quality of life after peroal endoscopy myotomy for achalasia

目的:评价经口内镜肌切开术(peroal endoscopymyotomy,POEM)治疗贲门失弛缓症(achalasia,AC)的临床疗效及生存质量(quality of life,QOL).方法:应用POEM术治疗35例AC患者,术后随访6 mo,采用Eckardt评分、胃镜及钡餐检查等资料评价患者临床疗效.使用36条目简明量表(SF-36)评价患者QOL情况.结果:35例患者均成功接受POEM术治疗,平均操作时间为56 min.术后6 mo Eckardt评分均较术前明显降低(0.45 vs 6.83,P<0.05),食管平均直径较术前显著缩小(28.50 mm vs 47.97mm,P<0.05),贲门口平均直径较术前显著扩大(32.63 mm vs 15.60 mm,P<0.05);并发症发生率为14.3%(5/35),随访期内无1例复发.术前各维度QOL得分除生理机能外均较常模低,其中躯体疼痛、总体健康、情感职能3维度差异有显著性(P<0.05);术后1 mo和6 mo 8维度QOL得分均显著高于相应维度常模值(P<0.05),8维度QOL及生理领域、心理领域平均得分亦均较术前显著提高(P<0.05);术后1 mo Eckardt评分与各维度QOL得分均呈负相关,术后6 mo Eckardt评分与躯体疼痛、总体健康、社会功能、情感职能、精神健康5个维度和生理领域得分、心理领域得分均呈负相关(P<0.05).结论:POEM术是治疗AC的一种安全有效的方法,短期内能显著改善患者临床症状及食管扩张的严重程度;AC患者POEM术前QOL低于常模人群,术后QOL显著提高,甚至高于常模人群;术后患者症状控制越好,其QOL越高.

AIM： To assess the short-term outcomes and quality of life（QOL） after peroal endoscopy myotomy（POEM） for achalasia.METHODS： Thirty-five patients treated by POEM were included. During the follow-up period（mean 6.4 mo, rang 3.5-10.0）, Eckardt score, gastroscopy and esophageal barium were used to assess clinical effectiveness, and the 36-item short form health survey（SF-36） was used to evaluate the quality of life.RESULTS： POEM was successful in all the 35 patients, and the mean operative time was 56 min. Mean Eckardt score（0.45 vs 6.83, P 〈 0.05）, esophageal diameter（28.50 mm vs 47.97 mm, P 〈 0.05）, and the diameter of the cardiac ostium（32.63 mm vs 15.6 mm, P 〈 0.05） decreased significantly 6 mo postoperatively. Complications occurred in 14.3%（5/35） of the cases, and no recurrence was noted. Preoperative scores of seven dimensions of QOL（except physical functioning） were significantly lower in the patients than in Chinese general population. After treatment, the scores of bodily pain, general health and role-emotional were significantly higher than preoperative values（P 〈 0.05）, even higher than those in the Chinese general population（P 〈 0.05）. Eckardt score was negatively correlated with the score of each dimension of postoperative QOL at 1 mo（P 〈 0.05）; and at 6 mo, Eckardt score was negatively correlated with bodily pain, general health, social functioning, roleemotional and mental health（P 〈 0.05）.CONCLUSION： POEM is safe and effective for achalasia, and can significantly improve clinical symptoms, reduce the dilation of the esophagus, and improve the QOL.